A Mississippi-based DC thrives by developing harmonious relationships with a neurosurgeon and a teaching hospital

Dominique Chagnon, DC, and Adam I. Lewis, MD.

Adam I. Lewis, MD, one of Mississippi’s top neurosurgeons, is the first to admit that Dominique Chagnon, DC, is a genuine miracle worker with a set of blades. No, not blades as in scalpels. Blades as in ice skates. That is how he and Chagnon became strong referral partners—by starting with a friendship based on their mutual love of hockey.

“It’s true,” says Chagnon (pronounced Shan-yo), owner of Action Chiropractic Clinic in Ridgeland, Miss. “We met about 5 years ago while playing on opposing teams in a community hockey league.”

In their initial encounter on ice, it was Lewis who got the better of Chagnon. “Dr. Chagnon is probably the best player in our league, but that day I tricked him into giving me a back pass, so that I could take the puck away from him, skate down to the other end, and score.” Somehow, Chagnon was not enraged. Quite the opposite, in fact. “We’ve been good friends ever since then,” says Lewis.

Common Ground
From debating one another in the locker rooms over game tactics and questionable calls by the referees, Chagnon says he and Lewis soon moved on to having dinner during which they would discuss cases they had been working on in their very different practices. Out of that emerged a realization that they each were treating a certain number of patients who would be better served by seeking the other’s care. Once that awareness took hold, they started referring back and forth. Chagnon was delighted to accept Lewis’s referrals, and the feeling was mutual.

“I knew for a long time that many people respond to chiropractic,” says Lewis. “Since I’ve always been oriented to trying things that will keep me on the cutting-edge of my field, I thought chiropractic was worth a closer look. The ball got rolling when I invited Dr. Chagnon to come by my clinic to go in on cases with me. I quickly saw that he could make a big difference by helping some of my patients avoid an operation.

“There were also those with certain joint disorders, malalignments and sacroiliac joint inflammations who could not be helped with surgical interventions. Now I have the option of sending them to someone who very likely can help them—Dr. Chagnon.”

Lewis admits, though, to having been skeptical at first. “I had this one patient suffering from vertigo,” he recalls. “Dr. Chagnon was confident he could remedy that. He told me the problem was with the alignment of the condyles of the skull with the cervical spine. I had my doubts, but after he realigned the base of the skull with the top of the spine, the patient’s vertigo went away.

“It was amazing. In fact, the more I learn about chiropractic, the more amazing a field I realize it is.”

Synergistic Duo
Chagnon with his associate, David A. Adkins, DC, whom he brought in to help with the increasing patient load.

A fair number of Chagnon’s total practice referrals originate with Lewis. The cases he sends are complex enough that Chagnon has found it necessary to modify his adjustment techniques to be able to properly accommodate them.

“We now have about eight different techniques that we can draw on,” says Chagnon, whose practice includes an associate, David A. Adkins, DC. “The techniques include high force, low force, and soft tissue. They are adapted as necessary, depending on the patient’s condition. Patients who have undergone recent surgery require a different approach. Some of the adjustment modifications were devised through trial-and-error, others were based on published research.”

Before Lewis refers to Chagnon, the two consult about the case to ascertain whether the patient is an appropriate candidate for chiropractic.

“Dr. Lewis,” Chagnon says, “shares the patient’s MRIs, the neurological and orthopedic exam results, and medication history—all the information necessary to make a good determination about how much help the patient is likely to receive by coming to see me.”

Chagnon’s assessment is thorough. “After ascertaining the patient’s symptoms, I then conduct a neurological exam, including reflex muscle strength. It took me a while to become really good at screening these particular patients. But I’ve worked with enough of them by this point that I can recognize the patterns suggesting whether the patient will respond to chiropractic care.” Still, there are surprises. “Patients who I thought would not respond actually end up responding beautifully. And, of course, on the flip-side, some patients who I feel very confident will respond, end up not responding at all.”

Chagnon says he tells his new patients right up front that getting better is not going to be a matter of just one or two treatment encounters: “I make sure they understand it’s more like a 2- or 3-month treatment plan, possibly longer. Throughout treatment, I monitor them very closely because I want to know as early as possible whether my efforts are paying off. If they’re not, I want to be able to refer patients back to Dr. Lewis right away for consideration of more radical interventions before their condition worsens.”

Whenever a case goes back to Lewis, the usual procedure is for Chagnon to discuss it with him by telephone. Simply sending a voluminous report of findings and hoping Lewis will find time to read it is not an option.

“That I can call to discuss these cases at length is a reflection of the good relationship we have,” Chagnon says. “Without that relationship, I don’t think I would have this much access to Dr. Lewis, which is a huge benefit to the patients.”

Growth by Referrals
Patient Chelsea Mills’ questions are answered as Chagnon describes her cervical condition. Patient education is an important aspect of chiropractic care.

Since teaming up with Lewis on patient care, referrals from other medical doctors now wend their way to Chagnon with growing frequency.

“Dr. Lewis has been suggesting to his colleagues that they give chiropractic a try,” Chagnon explains. “When a physician of Dr. Lewis’ prominence and reputation makes such a suggestion, others are willing to listen and act.”

However, some of his MD referrals originate instead with doctors whom Chagnon met on his own about 5 years ago when he decided to start giving overview lectures on chiropractic to third-year medical school students at University Medical Center, Jackson, Miss.

“These lectures have been important because, until hearing me speak, many of the students held negative views of chiropractic,” Chagnon tells. “A lot of them were under the misconception that chiropractors believe they can cure everything. What I do is try to give them the true picture of what chiropractic can and cannot do, and it’s invariably a real eye-opener for them.”

The first of those medical students Chagnon lectured have since completed their training and entered private practice. And, having remembered what he taught them, are referring with confidence to him and other chiropractors.

Much of Chagnon’s practice-building efforts today center around generating referrals, since he feels those are the surest means of keeping a chiropractic office on a solid growth track.

“Referrals are much more valuable than advertising in newspapers or mail-outs,” he contends. “Those forms of outreach have their uses, don’t get me wrong. For example, I advertise in the Yellow Pages®. It brings patients in. But, the type of patient who comes by way of a Yellow Pages advertisement is totally different from the one who comes by referral from a medical doctor. The MD-referred patient comes already confident in what I can do, whereas the patient coming in response to the Yellow Page ad usually requires an investment of time to familiarize them with me, the practice, and chiropractic in general.”

One of the first things new patients learn about Chagnon is that he hails from Montreal. He left Canada at 18 to attend Jackson’s Belhaven College on a tennis scholarship. After completing the undergraduate program there, he enrolled at Life University, Atlanta. In 1992, the ink barely dry on his diploma, Chagnon moved to Alabama where he signed on as an associate in an established practice.

Ten months later, he returned to Ridgeland, Miss, to launch his own practice. He opted to open there since that was where his wife was from, and he thought her ties to the community would help him more quickly build a thriving practice. He was right.

Chagnon’s interest in chiropractic arose from his exposure to the field as a patient. “I was 13 years old and playing hard at both hockey and tennis,” he says. “I injured my back from playing those sports, so I started seeing my parents’ chiropractor, Dr. Lafleur. I thought it was wonderful that I could be so greatly helped without the need for surgery or medication. Because of that help, I was able to continue with sports. But it also made me realize that chiropractic was what I wanted to do when I grew up.”

Recruiting the Best
Chagnon makes an anterior thoracic adjustment on a patient. His progressive approach to chiropractic has helped make his practice a success.

Currently, about 70% of Chagnon’s revenues are derived from insurance, including Medicare, Medicaid, and private (the remainder is split among worker’s compensation, personal injury, and cash). HMO penetration in Mississippi is not as deep as in most other states, and that works to Chagnon’s advantage when it comes to seeking referrals from MDs.

“As a result of managed care not being a big factor here, there’s less red tape for medical doctors to go through, [which means] a less pre-approvals involved before they can refer to me,” he says. “Doctors have more control over the care plan of the patient. The same applies to my own ability to develop care plans.”

Ridgeland is a suburb of Jackson, and is located in one of Mississippi’s most affluent counties. However, the patients Chagnon attracts come from all income brackets, as well as from all age groups and education levels. “It’s a good blend,” he says.

And, significantly, Chagnon’s progressive approaches to chiropractic are usually well-received in this market, which is noted for its conservatism.

“Patients here generally prefer to stay with what is familiar to them, the tried and the true,” he says. “But many people place a very high value on the recommendations of their trusted friends, relatives, and medical doctors. If the recommendation is to go see Dr. Chagnon, that’s what they’ll do, even if they’re not familiar with me or what I offer.”

Patients seeking the care of neurosurgeon Lewis sometimes travel from outside the Jackson market’s catchment area. The lengthy distances involved can make it impractical to refer such patients to Chagnon if it is determined that chiropractic services must be rendered several times a week. To sidestep that problem, Chagnon and Lewis organized a small, informal network of chiropractors closer to the homes of Lewis’s out-of-area patients. The chiropractors participating in this arrangement were recruited based on Chagnon’s familiarity with their work.

“I know most of the chiropractors in Mississippi,” he says. “The doctors I’ve asked to be in the network are all ones I’d go to myself if I needed care.”

Chagnon entertains the notion of developing a multidisciplinary office for himself, his associate Adkins, and other types of practitioners. It is not a high priority, though, since he finds his current arrangement satisfactory. Of more immediate interest is the possibility of teaming with Lewis on a lecture circuit to provide chiropractors with detailed technical information about working with neurosurgery patients. “I’m big on the idea of professionals from different fields working with, not against, one another,” Chagnon says.

The exception would be when those professionals work against one another on the ice. For it is there that practitioners going toe-to-toe and stick-to-stick can become the best of friends, as well as the best of referral partners. CP

Rich Smith is a contributing writer for Chiropractic Products.

Chagnon can be reached via email: dchagnon@jam.rr.com.