Intimidated and anxious ... this is perhaps the most accurate way to describe how most chiropractors feel when they approach medical physicians. For years, the medical community has cast doubt and suspicion on chiropractic and has been one of our industry's biggest critics, which makes any approach to the medical community analogous to walking into the proverbial lion's den. While medical physicians are interested in alternative care, including chiropractic, it is unlikely that they will contact us. Therefore, we need to approach them.

When it comes to promotions, medical doctors prefer a person-to-person approach no matter what product or service is being presented. With manipulation earning favorable reports for the treatment of back pain, many competitors are using manipulation as a treatment tool. Chiropractors must speak up before the competition does. The most intimidating part of promotions is making first contact with a medical office. This article provides you with the insight to feel less intimidated as you make first contact with medical offices to begin forging professional relationships and medical referrals.

The Front Desk (aka the Gatekeepers)

Any first contact with the doctor will go through the front desk. Once you get past the front desk, your focus will be on educating the physician about chiropractic care. However, the front desk can provide you with valuable information about the practice and their patients that will make your meeting with the physician more impactful. Let's examine how to form a rapport with the front desk of a medical office and the information they have that you want to make sure you uncover.

Three Types of Gatekeepers

Assistors: They are more than happy to help you meet the physician and provide information. They greet you with a big smile and a welcome.

Deflectors: They will pleasantly greet and speak with you. However, they are efficient at deflecting any questions and are proficient at keeping you from interfering with the doctor's schedule.

Blockers: They look at you with a look of daring. Dare to take their time, dare to ask questions, and dare to try to see the physician. They can be rude, abrupt, and abrasive. They tend to view their position as one of power.

Breaking Down Difficult Barriers

Most gatekeepers are assistors or deflectors. Assistors will help you immediately. However, deflectors and blockers will need more work. Here are some tried-and-true options to breaking down their barriers. The next two points may seem obvious, but I include them for the simple reason that many times they are forgotten:

• Overcome them with kindness. If you come upon a front desk that's less than friendly, answering hostility with hostility isn't going to get the front desk to take more time with you. The following techniques can be a better choice:
• Try to show up right before they take lunch or right after the lunch break. The beginning of the day is as busy in their office as it is in yours with patient phone calls and scheduling changes.
• If your only available time to market yourself is on a Tuesday morning and this is a busy time for the medical office, sympathize with the staff that you understand how busy they are and ask if there is:
• A better time you could return, such as early evening or lunch hour?
• Another staff member, such as an office manager, who could help you?
• Consider blocking out your own schedule to come at a more convenient time.
• Speak calmly and pleasantly. Walking in and introducing yourself with a loud voice can be annoying and disruptive, and will set the stage for creating an irritable front desk.

What should you do if you continue to be pushed away? It doesn't hurt to return with an enticement on the third attempt. For instance, bring them some good tidings. Items like pain gels, wrist pads, or lumbar supports will help to soften them up. People like to talk about their aches and pains, and in this case it opens up the door to conversation and rapport. Bringing items may seem like bribery in some form, but in most cases it will help you soften these especially difficult gatekeepers.

You Have Their Attention ... Now What?

Gatekeepers can provide a lot of necessary information on the practice that can be useful knowledge when you meet with the physician:

• What is their primary insurance company?

Knowing a physician's insurance profile is important. You don't have to match the doctor's insurance 100%, but if the front desk says 40% of their patients have Blue Shield, you should be a provider on Blue Shield.

• Who does the patient preauthorizations?

This person has valuable insight into the problems the doctor commonly encounters. For instance, using physical therapy as an example, you could ask the following questions:

• Do they experience problems with preauthorization for physical therapy? If their answer is yes, consider a patient who has the same insurance coverage in your office. Would a preauthorization be necessary? If not, you have just established a benefit of chiropractic referral over a physical therapy referral.
• How much administrative time do they spend obtaining a preauthorization? If it is a substantial source of their time or the doctor's time, can a chiropractic referral eliminate this task?
• Is there a particular insurance company that is especially strict or burdensome when it comes to preauthorizations? Again, would a referral to your office be easier for the doctor from an administrative angle?

Know your competition to determine your advantage. There are many competitors, but as an example, let's examine physical therapy:

• Where do they send their patients for physical therapy?

Is the physical therapist specially trained in manipulation? If the gatekeepers don't know, find out by calling the physical therapy office they are referring to. With the evidence-based research supporting manipulation for back pain, this is a very valuable promotional feature that you can use with the physician.

• How long do their patients typically wait for the first physical therapy appointment?

Some doctors may not see this as a problem. They may think that 2 weeks isn't a big deal. However, to a patient who is in pain, 14 days of no impact in their pain is a problem, especially if they can't work or care for young children. Can you decrease this wait time, perhaps even offer walk-in appointments? Economically and physiologically, is 2 weeks of fewer medications and a decrease in days on disability a better option?

• What is their insurance profile, and how does the copay for that physical therapy company compare to the chiropractic benefits for your insurance profile? In other words, will patients pay less out-of-pocket expenses at your office?
• Does an assistant perform the physical therapy versus your office, where you provide 100% of the care?
• What type of care do they provide, and can you match it? Can you provide more? Do they focus on active care or passive care? Do they address ergonomic issues? Even if your competition does but the doctor is not aware of it, you are doing a better promotional job by educating them on everything you can provide for the patient and will win the referrals.

This type of questioning is pertinent to any other therapeutic option the physician may employ, such as pharmaceutical (common problems that doctors find with this therapy is side effects or patient resistance to taking medications) and massage therapy (patients can incur significant out-of-pocket expense). You simply need to ask the questions that help ascertain where chiropractic services might be able to offer at least the same amount of efficacy (if not more) as their current first choice of therapy while solving the problems commonly associated with that therapy. This is known as the "meet and beat." In this example, manipulation is at least as effective as physical therapy for treating back pain (the meet) but doesn't require a preauthorization (the beat).

Meeting the Physician

Now that you have broken past the gatekeepers, ask them how to best meet the physician. Some offices may send you back right away; others may suggest scheduling lunch or setting up an appointment to meet with the physician. Make sure you bring some recent research on the efficacy and safety of manipulation in case the opportunity to meet with the physician presents itself immediately. If the doctor has only a few minutes, introduce yourself and your practice and ask the doctor if he or she has time in the near future to discuss the recent evidence-based research on manipulation for their back pain patients.

If the front desk suggests a lunch, you need to be aware that for most offices this means providing lunch for the entire staff. This does not mean that you have to provide an elegant lunch or take them to a 5-star restaurant—sandwiches and beverages are standard.

The Tools and Knowledge to Succeed

When you meet with the physician, you need to first promote manipulation and evidence-based research. Once the doctor understands the benefits of chiropractic care, the points outlined in this article will help make your promotional efforts competitive in order to change prescribing habits to win referrals.

Forging relationships with physicians is not difficult if you have the tools and knowledge to help you succeed. While you may have to step out of your comfort level at first, you will find the results are well worth it.

Christina Acampora, DC, is the author of Promoting Chiropractic to Medical Practices, a Jones and Bartlett text due out May 1. She is also the founder of Aligned Methods, a company dedicated to forging medical relationships by supporting the medical marketing and public relations efforts of independent chiropractic physicians. To learn more or to contact the author, please visit www.alignedmethods.com.