Chiropractor vs Physical Therapist

I agree Ryan, but with reservation.

As far as I am concerned, the APTA is not doing even nearly enough to promote PTs as back and neck pain specialists.

At times during the year I have been treating a patient for a peripheral injury and they will look at me in the eye and ask “Do you know any good Chiropractors for my back?”

I usually reply “I can be your chiropractor too” and ask them if they mind if I perform a Grade V manipulation on their thoracic or lumbar spine. After a successful “adjustment” they hear an auditory “pop.” The patient realizes they are in professional hands, and often they allow me to treat their spine afterward.

Is it the APTA’s fault? Perhaps a little. But we as a profession need to stop complaining and take a good hard look at ourselves. If our governing body is not doing enough to promote the hands-on aspect of Physical Therapy, then we must take matters into our own marketing hands.

We as a profession feel bad about charging patients the $15-50 copay, whilst getting reimbursed below acceptable rates by the insurance companies.

Patients going for dermatology services will often drop 1000 dollars upfront for services not performed for 3-4 weeks. This seems crazy to me.

PTs that have gone through college and university are only too aware of the debt they are left with, sometimes taking years to pay off.

Why don’t we stop negotiating with patients to lower their co-pays? Do patients negotiate with their Obs/Gyn or orthpaedic surgeon after their consultation?

These doctors would probably be insulted if asked the question, and perhaps ask the patient to seek treatment somewhere else?

Chiropractors market themselves brilliantly. We too can market ourselves brilliantly, if we take baby steps to start.

This is what I propose:

1) Stop negotiating with patients about co-pays. We as a profession need to stop devaluing our profession. If patients complain about fees, we can tell them to take up the issue with their insurance company, who sets the co-payment rate.

2) Offer a receipt for services with a bill breakdown instead, and get the patient to send their bill to the insurance company themselves to get reimbursed. Most patients will probably deny this service and go back to number 1, offering to pay the full co-payment amount

2) Put up signs around PT practices (at the front desk, bathroom, changeroom), stating “Did you know that PTs are regarded as back and neck specialists?”

3) Telling our patients that most PTs are trained in Spinal Manipulation or “Adjustments”

4) Online marketing of individual company websites stating that PTs are neck and back pain specialists. After all, insurance companies call us a specialists

5) Making a point of telling our patients if we reach the “Doctorate” level of education

I welcome any other suggestions…..for better PT marketing.

The main factor is patients generally want to be ‘fixed’; they want someone else to do the work and perceive they will get this from a Chiropractor.
I have a Chiropractor that routinely gives exercises and offers an exercise class that is recommended for his patients but has little participation.
We need a mind set change to evoke proactive participation in health care; then patients will recognize the value of our service. And BTW I have the misfortune of knowing too many Physical Therapist that do not give exercises because “the patients won’t do them”; it is crucial for us to remember our continuing role as educators if we want the system to change.

Also agree for the most part. I think this is something that is slowly but surely changing. I have seen a definite change in the media, most notably professional athletes making mention of having to do physical therapy, or mentioning that physical therapy is necessary for their recovery. I get excited when I hear athletes mention this, because our patients worship these guys! Also, more and more reports are showing the inefficacy of certain surgeries and procedures. Even groups such as the American Pain Society and AAOS have stated how important and vital PT is to patient recovery and admitting how many of their own practices are largely unsupported in the research.

As evidence based medicine continues to become the guiding principle medicine, I am confident that with time PT will become the most commonly recognized and most reliable form of treatment for all musculoskeletal ailments. I feel it is only a matter of time before insurance companies re-evaluate their policies/coverage of chiropractic (most often more coverage than PT) as the evidence is revealing its’ non-efficacy and potential danger (I just saw a patient who developed BPPV after a visit to her chiro). I believe what we really need to continue to push for is direct access and doing better clinical research so that we can prove to the insurance companies that what we do works!

I disagree with performing a manip on a patient just to show them we know how to do it and “convince” them we are experts. Just because you know how to do a Gr V makes one an expert? Does being able to do a Gr V make a chiro an expert? More valuable to our profession and our patients is for clinicians to take the time to explain to patients what we are doing and why and the sound clinical research that supports it.

Also, if you have problems with patients who try to negotiate lower co-pays, or even physicians who want a “professional courtesy”, the reply is simply that reducing or not collecting a co-pay is ILLEGAL! We have contracts with insurance companies that require the patient to pay and for us to collect. By reducing or not collecting co-pays, WE are in violation of this contract and breaking the law. I simply ask patients “Do you want me to break the law?”

WRT marketing, I’ve always believed in “the proof is in the pudding.” You are marketing everyday by making your patients get better and showing the true value of our profession!

you are absolutely right about that. We, as physical therapists, should be considered as an expert when it comes to the conservative management of neuromusculoskeletal disorders. We have far more in depth training in both the manual therapy and therapeutic exercises than any other professions. The reason that we are less well known than chiro because, in my opinion, we do not support APTA enough both financially and intellectually to fight for our interests and publicize our brands.

BTW, I am also open for this kind of discussion.

Hi, I came across this post while using Google…I don’t know how the healthcare system works in the US but would like to share some ideas re treatment modalities.
Currently, I’m a chiro freshman and judging by what our profs *perceive* PTs (private clinics at least) do ultrasound, TENS and exercise. In fact, some private chiro clinics hire PTs just to do ultrasound, TENS, cryo, etc
Due to chronic sports injuries and not getting much results from chiro manipulation, I decided to go to a physio and was impressed by the thorough assessment incl movement. Treatment was deep tissue massage to get rid of adhesions and scar tissue. I was then shown stretching and exercises… certainly improving a lot.

Bottom line is I think the general public is not aware of the treatment modalities PTs use and their effectiveness. (Then again, I don’t know if deep tissue massage / release is a norm among PTs)
A handful of chiros do release techniques.
just my two cents worth…

Hey Ben,
Unfortunately as much as I want to disagree with your professors, there are still many in the PT profession that utilize outdated, useless modalities just as many of the older chiros utilize subluxation theories and applied kinesiology which hold no validity or reliability. Fortunately for the PT profession, there is alot of evidence behind many of the other things that we do and alot of PTs are involved in investigational research to help better the profession.

As a student, I challenge you to reconsider why you got better after the massage…how can one speculate they broke up adhesions? We do know the PT put his hands on your “skin” and that the “skin” has loads of cutaneous receptors. Maybe the true effects were that he touched the skin in a way which allowed the brain to consider there is no longer a threat to that region of the body and the output of pain was inhibited. I welcome you to join http://www.somasimple.com to learn more….

I have a rather unique perspective on this issue. When I was very young I was helped by a chiro when no one else could, even the “Best Doctors at Children’s Hospital.” I grew up thinking of being a chiro as a career choice. I decided on PT school . I would sit and listen to the PT professors bash chiros and wonder what the problem was. Today, I have my DPT and own my own clinic. I often tell patients about my personal experiences to let them know I can see both sides. I sit and listen daily to patients tell me about how wonderful their chiros are, how they have been seeing them for years. They say it only helps for about 24 hours and then they hurt again. I let them finish and then I simply ask two questions. 1. Does your chiropractor teach you how to realign yourself when you come out of alignment? At this point patients just look at me confused. 2. Does your chiropractor ever teach you the exercises so you do not come out of alignment? Patients will say “They can do that?” Realizing they have great respect for their chiros I don’t comment anymore except to say “Go back and ask them to show you.” Every patient returns and says “I asked and they gave me a link for exercises” or “I asked but they said they would show me the next time.” At this point the patient “Gets it.” I tell them I am going to show you how to do this with household items safely, in fact I even put it on youtube because I was am tired of people getting milked for cash! Last week, I actually had a patient walk into my office stand in the middle and say “My chiropractor is going to be pist!” She went on to say I did those exercises and I feel like I do after I leave him.” She told me ” You are going to rehab yourself out of business.” I don’t write this because I think I am some hero, I am literally doing my job helping people help themselves.
On the question of why we are not the go-to for back and neck problems, my answer is simple. We are awful at marketing! Chiros are always out doing health seminars, public speaking, owning the web SEOs and self promoting. It is not the APTAs fault or anyone else each of us need to kick in and market what we do, that is how change is made. In a 7 mile stretch on my way home from work there are 5 chiro clinics! How do they compete? They know they have competition and they get out in front. We don’t do this, we just wait for orthos and neuros to refer. I just changed my marketing strategy and now I do what they do. I am growing my business by self promoting and getting out in the community. I resisted for years talking about my experience working in the NFL, NBA and with other pro athletes. If a chiro had this experience they would be all over TV. I am learning from them because I cannot imagine telling a patient to give me 6 grand and I will fix you in one year! But it is done everyday and they are doing well for a reason.
If any of you want those self realignment techniques go to youtube and look up Fmr. NFL PT in Tampa. I started a blog at http://www.PTandPainRelief.com.