August, 2014

Standing Out from the Crowd: Specialties that Have Traction Now

By Peter G. Fernandez, DC

Why should you develop a "Specialty" practice? Because insurance companies are making the practice of chiropractic extremely complicated and stressful. These complications and stressors include reducing payments for adjustments, exams, x-rays and therapy; reducing the procedures they will pay for; requiring pre-authorization of care ... thus denying necessary patient care. They have also created a tiering of doctor networks: If a DC ends up in a certain tier, they will be forced to change their practice methods or be dropped from the insurance network. They are restricting the number of DCs in their insurance networks, thus keeping the majority of DCs out. And they are dropping DCs out of their networks. Insurance companies have found that it is easier to manage a smaller network than a larger network.

Yet another issue is the audits of DC records, then demanding a return of money. Then there is evidenced-based chiropractic. If the DC doesn't comply with the insurance company's version of necessary services, the patient's care will be denied. Not to mention the excessive and unnecessary paperwork, most of the which is designed to help the insurance companies deny DC's care; and the denials of medical necessity. It's amazing to this author that a doctor who has never examined or treated a patient can deny someone's care

standing out - Copyright – Stock Photo / Register Mark This is the type of harassment that DCs have to endure. Unfortunately, the larger a DC wants to build his practice, the more of these hassles he'll encounter. And with ObamaCare, these hassles will greatly increase.

You Have to Change

What's a DC to do? CHANGE! The more our environment changes, the more we have to change with it. When the weather changes from summer to winter, we have to change to warmer clothes in order to endure the cold weather. When the weather changes from winter to summer, we change our clothes from wool and scarfs to t-shirts and shorts. The same principle applies to chiropractic practices. So, change! So how should you change? Becoming a "specialist" may be your answer.

For the doctors who want to remain insurance based, here's how to achieve an easier and more profitable practice.

Joint Practices: This is where multiple doctors join together to reduce their overheads. One x-ray machine and one insurance CA can serve 3 to 4 doctors.

Incubator Specialty: In this type practice, a doctor establishes a large chiropractic office and invites other DCs to join him. These clinics can serve 4 to 10 DCs with everyone making more money because of lower overhead and additional available services.

Rehabilitation Specialty: Insurance companies pay more for rehabilitation than for patient relief and patients need rehabilitation. After all, a DC's job is to reduce subluxations and then get them to stay in place. Rehabilitation gets the vertebrae to stay in place.

Specialties to Consider

Sports Injury Specialty: Almost every DC knows how to treat sports injuries because they are primarily strains and sprains. But, most sports injury patients only want to go to a doctor for three or four visits to get patched up and then get back to their sports activity. Unfortunately, this type of practice requires a large volume of new patients and is insurance based. Therefore, the more patients the doctor sees, the more hassles the doctor gets. However, there are advanced ways to specialize in sports injuries that are very profitable and cash-based.

Headache Specialty: Many chiropractors specialize in the care of the upper cervical spine. Their care is a natural for a "Headache Specialty." Headaches are the number two health problem that chiropractors treat, with back pain being number one.

Postural Correction Specialty: There are many chiropractic techniques that concentrate on the correction of posture. Every mother and grandmother are always saying to their kids, "Sit up straight," A doctor that specializes in fixing posture will have the support of every mother and grandmother in town. The Postural Correction practice is a stress free practice because the patients are not in pain and basically correct their own posture under the guidance of a doctor trained in postural correction.

Scoliosis Specialty: Chiropractic colleges and specialty organizations, such as the Clear Institute, are training doctors on how to correct scoliosis; not only adolescent scoliosis, but adult scoliosis. A Scoliosis Specialty Practice is also a stress free practice.  

Decompression Specialty: Many people suffer from a "failed back syndrome" and chronic pain. The Decompression Specialty is a natural for these patients. Decompression care relieves pain that no other type of care can.

Neuropathy Specialty: Approximately 20% of the population suffers from peripheral neuropathy. This is a painful, progressive degenerative condition that results in balance problems, difficulty walking and sometimes amputation. Specialized chiropractic care can relieve the pain of neuropathy and prevent its progression.

Functional Medicine Specialty: In this specialty the DC treats his patients like an Internist. The difference is the Internist treats his patients with drugs and the Functional Medicine DC treats his patients with vitamins and nutrients. The use of urine and blood chemistries guides the DC in determining what is wrong with the patient, proper treatment and the patient's response to care.

Nutrition Specialty: This specialty is almost identical to the Functional Medicine model. However, instead of relying on blood and urine chemistries, the DC uses a "cook-book" approach, i.e., Vitamin C or A for colds. Most people take vitamins, but they take the wrong vitamins and need a trained professional to guide them.

Joint Regeneration Specialty: This specialty only applies to DCs that use injectables. The injections of Ozone compounds, therapy and rehabilitation help restore joint mobility, reduce pain and retard the degenerative process.

Diabetes Specialty: This practice is very similar to the Functional Medicine Specialty but also concentrates heavily on changing patient's lifestyle choices (diet, exercise, weight loss) to fix Type 2 Diabetes.

Personal Injury Specialty: The specialty of personal injury is similar to the specialties of Orthopedics, Neurology and Roentenology. The DC must prove the patients' injuries are caused by an accident and be an expert in treating trauma.

Body Contouring Specialty: Almost everyone wants to get thinner without doing any work or dieting. Body contouring, through the use of lasers, cryo therapy and wraps can reduce three or more inches from a person's waistline in three weeks. This is a very profitable addition to a chiropractic practice.

Weight Loss Specialty: Many DCs have successfully added weight loss programs to their practices. Combining weight loss and body contouring specialties is a natural.

Cosmetic Chiropractic Specialty: Everyone wants to look younger. Many DCs offer non-surgical face lifts, wrinkle elimination, etc. Adding this specialty to body contouring and weight loss is very profitable.

Brain Mapping Specialty: This emerging specialty is a modification of how a patient's brain works. When a person injures themselves, a nerve pathway is established between the brain and the injured part. Treating the injured part is many times effective and the correction of the nerve pathways to the injured part is also effective. This may be why an adjustment works sometimes and sometimes it doesn't. My explanation of this specialty is obviously over-simplified, but this specialty does work.

Three Keys to Profitability

All these "specialties" are market driven. It takes an effective marketing campaign to inform the public of a DC's specialization. Specialty practices are only successful when combined with dynamic marketing.

These specialties are only successful if they are cash-based. If DCs want to bill insurances for these services, their specialty practice will be a disaster. The insurance companies will question everything the doctor does and deny payments for most of the doctors' services.

Specialty practices require additional knowledge and work. You must commit yourself to taking courses of instruction, studying and mastering your chosen specialty – because, you must be able to deliver what you promote.

The future of chiropractic will be bright for those DCs brave enough to embrace a "specialty."

Dr. Peter G. Fernandez, a graduate of Logan Chiropractic College, is a practice consultant with over 30 years of experience. He has written more than 20 books and over 200 articles on building a practice, and has consulted with 5,000-plus practices. Contact Dr. Fernandez with questions or comments regarding this article via e-mail ( ) or by visiting

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