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It’s that time of year again, (well at least for some of us) where it’s time for license renewal.  As I was pondering how to put this blog together, I did a little research to see the requirements for different states and different countries.  After about five minutes, my head started to spin and my eyes watered from all the variations. For all the newbies who are about to graduate, this blog is for you. As a youngin, me (we) have a tendency to think we know more than we do.  Especially when it comes to the old folks in our lives like parents and professors.  I graduated with my bachelors at 22 and my DC at 25 so looking back, I was certainly fresh faced and a bit idealistic. There was one thing I did do right though.  Keep on reading to find out more.   Listen to the Experts: Even before I entered into chiropractic school, I was all about looking up the requirements.  I wanted to know what I needed to get in to school but also what I was going to need in the future. The big debate at the time was about whether or not a DC was going to need a bachelors degree.  I was so hell bent on having as many titles as possible that this was a non-starter for me.  Of course I wanted the bachelors degree.  I discovered once I entered Palmer that was not the case for everyone.  Some of my classmates had elected to just do the minimum of three years (which is what you needed for Palmer at the time). The dilemma was, there was talk that many of the states were going to move to requiring DC’s to have a bachelors degree.  As it turns out, the State of Ohio (thats where I practice) did not require a bachelors degree in 2009 (when I graduated). In the summer of 2010, they moved to require the bachelors degree! The other dilemma was also about how many sections of the boards we should take.  Palmer told us to take all of them (and try and pass them) before graduating, that also included the physiotherapy section. At the time, many states were not requiring the PT part. Again, even since I have been out of school, states want all four sections of boards plus PT plus the bachelors degree.  If you were licensed in a state before all the changes, then they will grandfather you in.  However, if you want to move to a state with more stringent requirements than it’s back to the drawing board.   To sum it up…listen to the authorities for state licensing and in chiropractic schools.  If they say to get the maximum level of education and boards then do it. You never know what the future of chiropractic will look like and where you will want to live.   Specialize Once you decide that you have enough pedigree and know where you want to live (or possibly live in the future) the next step would be to start adding to the skill set.  For example, I am a big Activator fan. I had my advanced rating before I even graduated from chiropractic school.  In my mind, as a 25 year old what I didn’t have in clinical experience I could try and compensate with having more skills.  I just finished my first level Reiki training, I’m working on reflexology and eventually I would like to add acupuncture to my repertoire.  These might not be good fits for you, so find what is.   Watch the Trends A person doesn’t even need to watch cable TV anymore to know what’s going on in the world with all of the social media sites.  Watching trending hashtags, what people are talking about, etc and you can see where people are going.  Western medicine seems to be falling out of favor (just a tad) which seems to be allowing for other healing modalities like chiropractic. Kassandra Schultz DC
An Article Review Dynamic Chiropractic Feb 2020, VOL 38, #2   I opened up my latest edition of Dynamic Chiropractic and was very intrigued by this article. I just had to do a review!   Chronic pain is now at epidemic proportions in the western world. In the US alone, the CDC estimates 50 million Americans are suffering from chronic pain.  Low back pain being the biggest piece of the chronic pain pie. To make matters worse, 20 million Americans are experiencing “high-impact chronic pain.” High impact meaning it limits how much a person is able to work. Chronic pain in the US alone is costing upwards of $560 billion each year! That's a lot of zeros.   To compound the issue of chronic pain, for the last few years the majority of this chronic pain was treated with opioids. Opioid therapy became one of the medical standards when managing musculoskeletal pain. Living in the Midwest of the US, I have heard personal stories from folks about how the majority of their little town was almost decimated due to prescribed oxycontin.    The cycle becomes once the MD is no longer able to prescribe the opioid then in many cases the patient will turn to the “street pharmacy” and get heroin.    A personal friend of mine, had this exact experience with her former husband.  She came home (to their family home) and had found that her husband had committed suicide.    She feels he was not able to cope with the oxycontin/heroin addictions. He had originally been prescribed oxycontin for low back pain. I know that the police force in my area has been trained and now carries ‘Narcan’ with them at all times.  Narcan is the nasal spray that helps saves a person’s life when they are over-dosing on a narcotic.   According to the CDC…   “70,237 drug overdose deaths occurred in the United States in 2017. The age-adjusted rate of overdose deaths increased significantly by 9.6% from 2016 (19.8 per 100,000) to 2017 (21.7 per 100,000). Opioids—mainly synthetic opioids (other than methadone)—are currently the main driver of drug overdose deaths. Opioids were involved in 47,600 overdose deaths in 2017 (67.8% of all drug overdose deaths).   In 2017, the states with the highest rates of death due to drug overdose were West Virginia (57.8 per 100,000), Ohio (46.3 per 100,000), Pennsylvania (44.3 per 100,000), the District of Columbia (44.0 per 100,000), and Kentucky (37.2 per 100,000).1”   All that to say, the medical community is starting to admit that maybe (just maybe), opioids should be reduced in their frequency and distribution to patients.    As it turns out, if you read the medical literature they aren’t even that effective in treating musculoskeletal pain. There are more effective drugs (with less side effects) and other modalities which treat chronic pain way better like pain neuroscience education.   What is it? Pain neuroscience focuses on teaching patients in pain how to change their beliefs regarding pain. They get different educational sessions including neurobiology and neurophysiology of pain and how the central nervous system processes and handles pain.   Clinical trials/research are showing pain reduction at 3, 6 and 12 months markers plus improved function at the area which has pain and better mental health!   In the clinical trials, researchers have been putting together the neuroscience education with non-pain continent exercises and are seeing some very good results when it comes to chronic low back pain.   Here’s the kicker, they have seen that the typical patient with chronic pain who has been on opioid treatment reports no change in pain after two years of opioid “therapy.”  After entering a neuroscience education program, the average patient’s pain is reduced by 54.2%! Thats immense!   As someone who lives in Ohio (the second highest opioid crisis state), I hope the medical community starts taking modalities like this (and chiropractic) seriously. Currently, there is a tidal wave of opioid abuse and addiction which is destroying lives, families and the cities they live in. Kassandra Schultz D.C
With any kind of business, there are risks and potential financial blunders. Chiropractors have their own unique challenges along with the usual “normal” business problems. Let’s explore the top five biggest money mistakes a chiropractic office can make.   Letting Spending Run Wild I detest budgets.  In my next life I’m going to be independently wealthy or a trust fund kid. When it comes to spending money on things, I’m about as American as you can get.  Through trial and error (and lots of error), I’ve come to learn the value of having budgets.  There is freedom in having less debt and more cash on hand.  A rich guy told me once, cash is what can buy you options.  The more options you have, the more freedom a person has.  I think the budget for a chiropractic office from the get-go is so important, because most new chiropractor are swimming in student loans.  The last time I checked, chiropractors still don’t qualify for loan forgiveness through any US government agencies like “Doctors without Borders,”  “The Peace Corp” or working in under-served areas in cities.  Unless you have a bunch of greenbacks stashed under your mattress to help supplement cash flow during the lean times, it’s important to squirrel away as much as possible. A couple sub-categories I would like to touch on would include keeping credit cards low, not taking out anymore big loans, hiring too soon and keeping overhead as low as possible.   Visions of Grandeur Entrepreneurs are the dreamers and creators of the world. Small business owners take on a huge amount of risk and liability, sometimes struggling for many years, can put themselves in financial peril but the rewards can be so great.  Financial freedom, more time, a schedule you like and the potential to contribute more to the world.  Entrepreneurs don’t like being the cogs in someone else’s machine. The flip side is, it can be easier to get caught up in the glitz and glam of small business before success has truly kicked in.  Spending too much money too soon, too much overhead, payroll fancy buildings or cars can all become huge burdens. Just like with anything in life, businesses seem to be their own living, breathing entities.  As such, it can take longer and be a much more arduous road to sow compared to pie charts, projections and snappy excel sheets.  Running a business is a marathon not a sprint so, keeping expectations in check and reasonable will make the venture a little smoother.   Not Finding Your Niche Spending your money on gaining more knowledge and finding a niche will potentially add more value to the business in the future.  The more specialized you become, the more money you can charge for services.  Gaining more knowledge is money well spent.   Not Having Adequate Protection Against Risk Making sure from a malpractice perspective, umbrella insurance, disability and/or any other insurances have enough coverage.  For example, I have a one million/ three million occurrence policy with up to three occurrences/ year.  I know in the States, you have to have malpractice coverage  in order to accept insurance.  In our litigious society, I could not imagine not having proper coverage.  Add this necessary evil to your budget!   Failure to Use Professional Advisers Another important part of the budget would be to add in professionals when the practice and budget grows.  The first person I ever hired was an accountant.  I worked it out with him so as a new business I paid less in the beginning than I do now. A great accountant can shield you from more legal liabilities, not overpaying in taxes, budgeting, setting up business “flow throughs.” As the budget expands, adding in other professionals for marketing, etc will help you be more productive as the business owner, see more patients and then allowing mental space to continue to grow the business.   Kassandra Schultz DC
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