Why do MDs and PTs Not Refer to Chiropractors?

Historically, medical doctors and physical therapists did not refer patients to chiropractors because they did not understand the benefits of chiropractic care and they didn’t want to risk losing patients. Chiropractic care’s holistic approach to healthcare and overall wellness has recently become more appealing to patients and doctors.

As a chiropractor who has been practicing for over 25 years, have you received patient referrals from medical doctors and physical therapists? And do you find this is not the norm, or is it becoming more common?

Dr. Gregg Rubinstein: Well, it’s definitely becoming more common. Chiropractic is getting more and more acceptance, and more and more people are using chiropractors, but still not as many as we think there should. And really, I’m of the mind that if you have a spine, you should be seeing a chiropractor, just like if you have teeth, you’re going to be seeing a dentist. I mean, no one’s better at spine care than we are, and particularly on the preventative side, which is really where we want to be.

I find that it’s definitely more common, but when you go back to the old school, when you look at the medical doctors, they didn’t really understand what chiropractic was, especially with the holistic aspect of it, and it was more common in the days of old for medical doctors not to refer to chiropractors, because in reality, what happened was chiropractic was almost unknown until it was discovered in 1895. And then, when chiropractors started getting access to people, it was really the medical rejects. It was all the people who got no help with the medical profession, and then they were like, “Oh, I’ll try one of those crazy chiropractors.”

But what was happening is we’re competing for market share. All of a sudden, there’s these new people on the scene that patients are going to, paying, and the doctors were actually losing money. So, the AMA, the American Medical Association, and big pharma were pretty upset by that because in reality, chiropractors, what do we always say? Try chiropractic first. No drugs, no surgery. Those options will always be there later. So, we’re cutting into their market share. So, the actual AMA made a campaign to slander chiropractors, and specifically telling their medical doctors not to refer to chiropractors. And then in, I think, the ’70s, there was actually an anti-trust suit won by chiropractors against the AMA, and all they did was issue an apology and went on their own merry way. But in reality, it’s becoming more common now, but back in the day, because we were competing for market share and financial stuff, they were not too happy with us and did not want to send people to chiropractors.

It’s becoming more common now, so I enjoy it. I do get plenty of medical-doctor referrals, and I get some referrals from physical therapists, but physical therapy is really in direct competition for chiropractors who focus on back pain and neck pain. Thank God, my office focuses more on pediatric, maternity and family care, so we’re not really competing for the same thing, because it’s not pain-based care. It’s usually about optimization and birthing and all those types of things. So, it’s good to have a little bit of a niche practice, but it’s definitely getting better these days, for sure.

It sounds a lot like you answered my next couple of questions, but I’m just going to ask them anyway to see if there’s anything that we left out. When it comes to medical doctors, what do you think the reason is that they are hesitant to refer a patient to a chiropractor?

Dr. Gregg Rubinstein: I definitely think competition is part of it, and a lot of it is just they don’t really know, because they’re not really taught anything about chiropractic in medical school. Some of the older professors might have said, “Oh, chiropractors are quacks,” or, “It’s bad,” or whatever, and that “It’s dangerous”. But we’ve talked about the thing about chiropractic being dangerous. It’s not dangerous, because if it was, my malpractice rates would be really high. I always brag about it, and I say, “I pay $2,300 a year for my malpractice insurance”, and that it costs more to insure my car than it does to insure my practice, because chiropractors generally aren’t hurting people. Those malpractice rates are based on how often your profession gets sued or how often your profession hurts people. And again, I’ll put our safety record up against any other profession out there, because our malpractice is so low. Insurance companies are smart people. They wouldn’t provide us with a low rate if what we did was risky. So, this whole idea that chiropractic is unsafe is really a bunch of hooey, and I’m really glad that we’re getting over that, and I’m glad to talk about that.

They also like to refer directly to the physical therapist because they’re in control of the PT, because they have to write a referral. Up until only relatively recently, physical therapists weren’t portal of entry. You had to be referred to a PT. Chiropractic has always been portal of entry. We’re allowed to do the initial intake and determine what course of action we have. So again, there is some element of control and things of that nature, but in general, I definitely think it’s getting better and we’re all playing in the same sandbox.

Related to that, again, now for physical therapists, it seems that they would take the more holistic approach to healthcare like chiropractors do. So why would they not refer a patient to chiropractic care?

Dr. Gregg Rubinstein: Again, it’s definitely about competition in the marketplace, but physical therapy is really specific exercises to resolve a specific problem. It’s not truly holistic, right? Holistic is about enhancing the whole body. Again, if I sprain my knee, I’m going to get specific types of therapy, specific exercises to do, electric stim, ice and massage and all these different things, which are all good for you and will help your body rehab that knee or rehab your neck or rehab whatever it is you’re trying to rehabilitate.

But as far as spine care and a holistic approach to their health, which is optimizing the nerve system, nobody else does spinal adjusting to remove nerve interference and optimize the nerve system. That’s specific to chiropractic, and that is our niche and that is really what we do. If we put that forward, we eliminate the competition, because competing for back-pain and neck-pain patients with physical therapists is not what I want to do. If someone’s in a bad accident and they need rehabilitation, I’ll certainly adjust their spine, but they might need physical therapy at the same time.

So, everyone’s allowed to have more than one condition and allowed to have more than one approach to their health. But holistically, chiropractic has everyone beat hands down because all these other practices, physical therapy, massage, they’re not holistic. They’re good for you and they’re non-drug or non-allopathic, but they are specific types of treatment, not for holistic approach and optimizing the body and optimizing health.

Now you also talked about this a little bit, but from your experience, do you know if medical doctors and physical therapists are taught anything about chiropractic care during their training?

Dr. Gregg Rubinstein: Not really. They don’t really talk about our chiropractic principles, about what we call the vertebral subluxation, detecting and removing the vertebral subluxation, which is that misalignment. All they think is that we’re just another form of rehab, and that we do the same thing and that we’re redundant to physical therapy. And that’s why they think, if it’s redundant and we don’t have the same credentials and we’re not controlled by the medical doctors, that they’d rather just keep it in house. Because a lot of big rehab centers are owned by orthopedists and owned by physical therapists at the same time, so they keep all the money in house. It certainly has a financial aspect to it, but they’re really not taught that much about it in school. And even some medical schools are still saying, “Oh, chiropractors aren’t real doctors and don’t refer to them.” So, there is still some of that talk, just not to the same level as it used to be.

How do you think patient care and patient outcomes could be improved if medical doctors, physical therapists and chiropractors had a more accepting system of referring patients?

Dr. Gregg Rubinstein: Well, that’s a really great statement, and in that ideal world, we could all get along, but it really would require doctors to be more open-minded and to really ask the questions and listen to our holistic approach. Once they understand it, they get it, because I know that there is a power inside every body, an intelligence that runs, regulates and heals the body, and no doctor in their right mind would ever cut open a patient if he didn’t think after he did what he needed to do that that body was going to heal up and knit back together and close the wounds and replace the damaged cells with healthy new ones, because that’s how the body works.

So, if you optimize the body, it doesn’t matter what you throw at it; it’s going to heal, run and regulate better. And that’s what chiropractic is. It’s about optimizing the body, optimizing the nerve system, not just, “Oh, you have back pain or neck pain. We can help you with that.” So, if you look at it from that point of view and know that you’re optimizing the body with a holistic approach and making that body function at a higher level, if you put drugs into the body, then the body’s going to process those drugs and get it to the right place and then break down the toxicity of that drug in a better way and in a stronger manner. So, it’s going to be more efficient.

So basically, when the body is less stressed, it’s going to heal quicker. Quicker healing, because healing is an inside-out job, that’s what really is important. But if I get something that’s outside the scope of my practice or it’s recalcitrant to the treatment that I’m providing or outside my scope, I’m going to send that person to the proper doctor, to either a physical therapist or an orthopedist if they need to have a look.

It’s interesting, because we treat people with all kinds of conditions, but we don’t really treat conditions. I don’t treat cancer, but I treat people who have cancer. I don’t treat headaches, but I treat people who have headaches. And sometimes, eliminating nerve interferences makes the body healthier and people are better able to deal with it.

With more open-mindedness, I think better outcomes will be there if everyone was under chiropractic care, just like if everyone was just more fit and more healthy, they’re going to heal faster, too. It’s just another piece of the puzzle. I think it’s great when people really understand what other professions do and there’s all that great cross-referral, because I have some great relationships with medical doctors and physical therapists. Then there are other people who are really hesitant or don’t really understand what we do.

Learn More

To speak with Dr. Gregg Rubinstein, visit www.ChiropractorMidtown.com or call (212) 977-7094 to schedule an appointment.

Click here to receive more information & to schedule your consultation.

Call Now Button