In the last few years, the multidisciplinary practice has become fairly popular. I have found the multidisciplinary approach very beneficial to the practitioners. Because of the fact that it has become so popular, it is only natural for it to come under some attack. There are, and always will be, disagreements and differences of opinion on many subjects: religion, politics, or the straight versus mixed-type practices, to name a few. There are and always be great differences of opinion on most any subject.
I have been involved in mutidisciplinary practice since 1982, and have seen all aspects of the concept. I think with anything the purpose of why someone chooses one concept over another has much to do with the efficiency of that practice. Doctors sometimes ask me an unusual question: "How long do you think this MD/DC concept will last?" It's as if they believe that when the powers that be, whoever they may be, find out about this, it will be all over.
First of all, when a few people come under attack from various agencies, some people will think, "I better not get involved in this, it is wrong." People who are already in a multidisciplinary practice might think, "I better get out of this, it must not be ethical." I think this is very unfortunate.
The idea of chiropractors being involved with MDs in practice is a new concept, but it has been practiced for years and years by other groups. Hospitals are involved with MDs in a practice group, with each member of that group providing services: the MD seeing the patients; the hospital providing the facility, equipment, billing, management, protocol, etc., and both parties are making a profit. Walk-in medical facilities are set up the same way: a management company and a medical corporation in a team approach.
HMOs hire physicians, and some larger companies have their own medical clinics owned by the company. All of these groups have been doing this for years and are set up to function almost exactly like the MD/DC practice structure.
The multidisciplinary practice is much more difficult to operate. It takes a great amount of management skills and there are many more rules and guidelines, laws and protocols to follow. This type of practice is certainly not for everyone. I have seen many practitioners that have gone into the multidisciplinary practice that should never have gone into it. They were not willing to pay the price of learning to develop the skills and went into it for all the wrong reasons.
There is a positive side. When a broader scope of practice (like a multiple service concept) is offered, there is much more available for the patients. When the multidisciplinary practice is done properly, legally, and functions correctly, the practice usually grows tremendously, developing more new patients, a much larger patient volume, and so forth, because a broader scope of practice is available and offered. Another major reason why this is such a great concept is because approximately eight percent of the population go to chiropractors, and approximately 98 percent go to medical practices. In a multidisciplinary practice, the chiropractor gets an opportunity to offer chiropractic care to a much larger segment of the population (who would have probably never sought out a chiropractor as part of their care). This fact alone causes the multidisciplinary practice to grow extensively.
I will admit it is much tougher to develop and manage, and it takes a change in concept; more time; more money; and a lot of determination; but for those who prevail, their practices usually grow greatly.
The multidisciplinary concept has brought medical doctors and chiropractors together for the benefit of the patient. In most circumstances, the patients say that it is about time that MDs and DCs work together. I have seen in almost every instance a much better understanding of each professional health care approach, a concept that both the MD and the DC see the value in. The patient sees the best of both worlds.
It is not something just anyone should go into without a lot of thought. It is very important that the practitioner gets very sound legal and management advice. The doctors must be willing to research state and federal laws, referral concepts, and advertising laws, among others. Practitioners must be responsible on their own. Do not do a multidisciplinary practice unless you are willing to be responsible for your own actions. But just like anything else that is tough to accomplish, it is also very rewarding and self-satisfying to accomplish a more difficult and broader scope of practice.
The idea is to bring both aspects of the practice for the good of the patient.
Ron Halstead, DC
President, Practice Systems
Scottsdale, Arizona
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