Volunteering helps this practice get more than half of its new business from physician referrals.

The golden rule is not just an empty phrase for John M. Ventura, DC, DABCO, and Brian Justice, DC, DABCO. For the two Rochester, NY-based chiropractors, it is the foundation of their lives and their practice.

For the last 20 years, the two chiropractors have been volunteering at the Mercy Outreach Center, a medical center designed to serve the needs of the area’s homeless, destitute, and working poor. “As a facility, it is meant to catch people who fall through the cracks,” Ventura says. “We tend to see a lot of legal immigrants.” The center is administered by the Sisters of Mercy, a Roman Catholic religious order.

The road to volunteering at Mercy Outreach began quite by accident. One of Justice’s patients was the director of a local soup kitchen and told the chiropractor that many of the soup kitchen’s clients were coming in with numerous medical complaints. “Brian and I were practicing separately at the time, and we both had a desire to give back to the community,” Ventura says. “So we offered our services for an hour a week.”

Eventually, the two men—who were in practice together by then—decided to offer their services to the Mercy Outreach Center.

Volunteering at the Mercy Outreach Center and being actively involved in the community has netted Justice and Ventura many patients. This has taken place almost exclusively through referrals from other physicians with which they have served during their community activities.

Giving Back
A single phone call to the director of the Mercy Outreach Center about the possibility of providing volunteer care to the facility’s patients was the extent of the effort needed to become a member of the medical staff.

The full-service family care center includes dental, pediatric, and social work services among its treatment menu. Initially, Ventura and Justice volunteered to come in a couple times per month to adjust patients. Now, that frequency is a bit more—sometimes as often as once per week, with a chiropractic intern in tow. They typically treat 24 patients per session there.

The center, though a charity organization, is run just like a private, for-profit medical group. Patients make appointments to get treatment and receive referrals and follow-up care. And most important, “the same standard of care applies,” Justice says.

Both Justice and Ventura’s regular malpractice insurance covers their work at the center. Some doctors in other specialties had to pick up an extra rider, and the center makes sure that all of the doctors, including Justice and Ventura, have up-to-date coverage. Neither chiropractor receives any compensation for their work at the center.

There are differences, however. “There’s a lot more co-morbidities in the patients we see,” Justice says. For instance, a patient with back pain might not really be a chiropractic patient at all; he or she might have an undiagnosed tumor—something that Justice and Ventura might not see as regularly in their private practice. This condition would likely be discovered by a referring physician.

Because the center offers integrated care, the patient record is all-encompassing as well. So the chiropractors—or any of the other specialists at the center—can get a full picture of the patient from their single file. Referrals are also common among the specialists. Justice and Ventura regularly receive and make referrals to the other physicians at the center.

Mechanical back and neck pain are the most common conditions that the chiropractors see at the center. After that, they commonly see patients complaining of tendinosis—particularly of the rotator cuff and elbow—and headaches. Many of these are work-related injuries.

The most common techniques Ventura and Justice use include diversified, soft-tissue Graston, and Activator. They also do exercise instruction and some wellness instruction.

In addition to having more co-morbidities, the chiropractors face other challenges in volunteering at the center. For instance, the center has 50 free x-rays per year, provided by a nearby imaging center. So, a prescription for an x-ray has to be evaluated more than in the for-profit world. “You have to be very discriminating [with the center’s resources],” Ventura says.

The center does not have the same quality equipment as a modern for-profit office. “We don’t have the same equipment array,” Justice admits, noting, however, that the center will soon be getting a flexion-distraction table—a service that the men offer in their private practice but not at the center.

It is not just treatment decisions and lack of the most modern equipment that presents challenges; follow-up can be an issue as well. But the center has a very effective method to make sure that patients return for follow-up care. The office staff tracks down errant patients—most of whom live in the neighborhood—using methods such as enlisting the help of other patients.

With all the challenges involved, volunteering at the center is something that both chiropractors love to do. “You get a lot back,” Justice says. “Going there allows you to just be a doctor—it’s very pure.”

The center is just one of the chiropractors’ community-service activities. They serve on several other community-based medical and service committees, and they have given their time and expertise to help set up chiropractic care services at other hospitals and charity facilities.

But volunteering has had more than a spiritual reward for Justice and Ventura. The chiropractors have benefited in other ways from their community service.

Getting Back
“Community service is a two-way street,” Justice says. “A lot of what service does is build trust [with other physicians].”

Justice notes that in many cases, likability and skill have been the factors in getting the referrals from physicians with which they have served during their community activities. “Many physicians will refer to you if they like you first,” he says. “John and I really don’t do advertising. We’re accepted and integrated into the medical community.”

The practice has been built almost exclusively through physician referrals—about 50% to 70% of new business comes from physicians—with most being a direct result of the two chiropractors serving the community.

Justice notes that a derived benefit cannot be the motivation for community service. “Some doctors do community service to build their patient base, but that is not the way to do it,” Justice says.

The first motivation has to be the community—the service itself. “We like to think in the long term that we’re here to help the community [with the chiropractic perspective],” Ventura says. “In that, we need to take an active role.”

But community service is not simply to society at large. The two chiropractors have also helped the chiropractic community—and themselves at the same time—by spreading the word about chiropractic to the traditional medical community through grand rounds.

In the Lion’s Den
While Justice and Ventura pursued their community-service opportunities, in 1989 the request to lead grand rounds at a local hospital came to them. “A physician at the hospital said, ‘Let’s do something radical—have a chiropractor come in to find out what that specialty is all about,’ ” says Ventura, who eventually made the presentation.

The reaction was less than enthusiastic. “About half of the doctors didn’t even want me there,” Ventura says. “They were obnoxious.”

Afterward, several of the physicians in attendance that day sent Ventura invitations to come speak to their departments and office staff.

As with their community-service activities, the two men have been proactive in pursuing grand round opportunities. They followed up with appearances in front of family-practice and occupational-medicine groups, doing grand rounds for them.

This has led to a greater understanding about chiropractic throughout the Rochester medical community. Ventura and Justice regularly host orthopedic interns in their office for a chiropractic rotation. According to them, they are the only chiropractors in Rochester who have hospital privileges.

The impact these grand rounds have had on the medical community is measured in the subject of the presentations. “Originally, the grand rounds were more based on our breadth of knowledge. Now, we speak on more specific subjects,” Ventura says.

Mini-grand rounds in physicians’ offices are the primary way the two men now actively market the practice. These meetings are usually one-on-one interactions. And this direct approach has been very successful. “If you market directly to providers, you usually get several patients,” Justice says. “[Typically] we don’t have to sell them on chiropractic.”

Grand rounds and community service are only a part of Ventura and Justice’s lives. They also have a practice with four offices employing five chiropractors.

Patient-Oriented Care
Rochester Chiropractic Group LLC uses the diversified technique, flexion-distraction, and electrotherapy. The group provides exercise rehabilitation and has an athletic trainer on staff. “We take a very patient-focused, patient-active approach,” Justice says. “This includes lots of exercise.”

The main office sees about 150 patients per week. The majority of new patients come from physician or patient referrals. The group’s Yellow Pages advertisement occasionally nets a patient.

All billing and administrative duties are handled by the primary office, with the satellites—which are smaller and open only a few days per week—focusing on patient care. One of the satellites has the advantage of being located in a medical facility owned by Blue Cross.

The group owns the building housing its main office. It rents space to a psychology group, a physical therapy practice, a hypnotherapist, and a massage therapist. This allows for numerous cross-referral opportunities.

Ventura and Justice are also diplomates of the American Board of Chiropractic Orthopedists (DABCO). This postgraduate program involved 400 hours of coursework, culminating in a two-part written examination. The certification has had personal and professional benefits. “It has made us become good clinicians,” Ventura says.

Justice is perhaps the most philosophical when looking at the benefits that community service has brought to the community and their practice. “When you give back, good things happen,” he says.

C.A. Wolski is a contributing writer for Chiropractic Products.