Dr. Jeff King: A Multi-Disciplinary Team-Based Approach to Patient Care

In this episode, Dr. Jeff King speaks in-depth on the Multi-Disciplinary Team-Based approach to patient care; the importance and examples of how he communicates with patients, the Fellowship Program at the Medical College of Wisconsin, and advice to students on how to “get noticed” when it comes to applying for a position within an established practice or medical organization.

Transcript

SPEAKER_01 0:39

Dr. K is Dr. Five Conseth Conset. Today, just the multidisciplinary based approach. Important example of Facebook based criteria. And what to expect from that collective program. I hope you enjoy my conversation with Dr. Jeff. Dr. Jeff K, how are you doing today? I'm well, sir. How are you? Fantastic. Fantastic. The first thing I want to do right out of the gate, Jeff, is thank you for taking the time to speak with me today. Of course, happy to be here. Thanks for having me. So let's get right into it. So you are a chiropractor and you work for the Medical College of Wisconsin. So that's a unique scenario. Very different than what 99% of the other chiropractors in the state of Wisconsin do. So why don't you tell me a little bit about that arrangement, how it got started, and a typical day of Dr. Jeff King?

SPEAKER_00 2:24

Yeah, absolutely. So if we start at the beginning and how it all got started is um, you know, back in the mid-90s, uh there's a neurosurgeon at the Medical College of Wisconsin, Dr. Dennis Maimon, and he wanted to build out a integrative transdisciplinary uh spine program. And Dr. Maimon was a bit of a visionary, and he understood the importance of having chiropractors involved in that. And so there's actually been faculty members at the Medical College of Wisconsin since 1995 or 1996. Um, and so it started with one, and then now we've grown that um to the point where we have five faculty chiropractors now uh within the Department of Neurosurger at the Medical College of Wisconsin. We see patients at four different clinical sites, and uh we get the opportunity to collaborate with a wide variety of medical professionals on a daily basis, including neurosurgeons, orthopedic spine surgeons, uh PM and R physicians, PT, OT, pain psychologist, anesthesia pain management are all housed right in one clinical space. As the director of the group, my day-to-day job varies a bit. You know, so I have a number of different hats that I wear. I'm still a practicing clinical chiropractor three and a half days a week. Uh, I'd spend two and a half days in our adult practice. I spend one day um at Children's Wisconsin in the Pediatric Spine Center there in one of their outpatient clinics. And then um I have a day and a half of administrative time to fill other roles as the director of the of the group. I sit on our spine service line uh steering committee for the institution. Uh, and I also have a half day of administrative time to be uh what's called a provider informaticist for the institution. So we are sort of tasked with reviewing and making adaptations to our electronic health record system uh to best fit the needs of our providers and our patients. So I get to do a lot of different things in the week, which is really enjoyable for me. You know, now that I've had the opportunity to do that, I I don't know that I could go back to doing just one of them 40 hours a week. Well, I get to do a lot of different things day to day, which I enjoy quite a bit.

SPEAKER_01 4:34

So in your practice life, the three and a half days a week that you practice, are most of your patients coming from colleagues, medical professionals as a referral, or like a lot of chiropractors, personal referrals from family members and type of thing?

SPEAKER_00 4:50

Um both and I would say, you know, um the bulk of them are coming from referrals from other providers, whether those be internal to our our clinic. Uh we have a really strong relationship with all of our primary care teams. So we get a lot of direct referrals from primary care, uh, straight to sea chiropractors. We're working on growing our relationship with our emergency department and our urgent cares to grow the number of referrals for acute back pain that's presenting to their settings to kind of let those patients feel like we've got a plan for them. So that's a growing niche. And then we also um we also get about 500 referrals a year from our OB teams to help manage uh peripardum back pain. And that was a really great program that was sort of spearheaded by one of my colleagues, Dr. Drake Whitcomb, um, many years ago. Um and that's become a really, really wonderful relationship uh with our OB teams and um to help manage those patients, uh, those pregnant women with back pain, because there's not a lot of other options for them to manage their pain. So that's a really, really fun patient population to work with. And then of course, we also have a lot of patients who either a friend, you know, we saw a friend or family member and now they want to see us, or they get on their health insurance, you know, website and they plug in their zip code and they find us that way. Um, you know, or they just happen to know through word of mouth that that Freighter and MCW has chiropractors and they get they get the rest of their care at Frederick and MCW. So um they they want to see their chiropractor here too.

SPEAKER_01 6:15

That's just still I've developed relationships with orthopedic spine surgeons, neurosurgeons. And oftentimes when you get those referrals, it's the complicated patient. It's the patient that's been around the block several times, whether it's previous chiropractic, physical therapy, spine surgery, injections, all of that gamut of care. But in your setting, I'm hearing that you most likely receive the non-complicated back pain patient as well from primary care, emergency obstetrics, that type of thing. So you have a wide variety of care, not just the seriously complicated patient.

SPEAKER_00 6:50

Yeah, yeah. You know, it's um, you know, it's I think it gets back to that idea of you know liking a variety, right? I think if you just did one thing over and over and over again, it could start to feel mundane. But you know, my um, you know, clinic day yesterday, for example, you know, my new patients were some uh pregnant patient, uh referral from primary care, a couple referrals from uh our surgical teams for you know people who maybe had a dyscectomy for ridiculopathy, and but now they're having persistent axial back pain, you know, that didn't respond well to the surgery. And so, you know, they'll they'll get those people over sooner rather than later. Um and that's a pretty fun group of people to work with, um, you know, or I've got a couple of patients right now where they've had a previous dyscectomy, now they've had a reherniation at that level. And now we're trying to help them avoid a second surgery. And so it's a big variety exactly, as you said, which is which is a lot of fun.

SPEAKER_01 7:44

So I've been in my independent practice for 30 years. I have colleagues, other chiropractors, we have physical therapy in our office as well. You're obviously in a large medical establishment. Where do you see the future of chiropractic? Do you see it still continuing in private practice? Do you see it gravitating more towards medical establishments? Can you speak to that?

SPEAKER_00 8:06

Yeah, so I think we're seeing a growth uh nationally in terms of sort of integrated health centers bringing chiropractors in. And I think that's you know, that's being driven by a few things. One, the quality of the research showing what we do is effective. And the other thing is, you know, I think what we're seeing a trend towards is we're seeing large healthcare centers, you know, they're changing the way they interact with payers, right? And so they're starting to want to develop situations where they have like shared risk contracts with payers, bundled payments for um specific diagnoses and different things like that. And so from that standpoint, given that chiropractors are the most common entry point for back pain of any provider type in the country, I think healthcare institutions are starting to realize that that's gonna be a value add for them when they're going and working with payers to negotiate these these types of different contracts. What I what I don't know is just because I I don't live in the same world as you, you know, I don't I don't know what that'll do to the to a private practice. You know, um obviously patients are always gonna have their their ability to choose as they should. I'm not deep enough into the world of of third-party payer contracts to to know what that looks like. But I think we're gonna see a continued growth in the number of healthcare institutions that are bringing chiropractors on board. I mean, even if we just look in the state of Wisconsin, uh MCW is not alone. Um, you know, Aurora has chiropractors on staff, Marshfield Hospital has a chiropractor on staff at their Beaver Dam hospital, Gunderson Lutheran has. Uh they've had a pretty significant amount of growth in a short period of time. Um, you know, they're up to three chiropractors now. You know, so we're already seeing this trend. VA within Wisconsin is growing their chiropractic team. So I think we're gonna see that grow uh as long as people like myself, you know, do a good job. So I think that'll be a growth trajectory. I think we're also seeing chiropractic students that I'm speaking with, and obviously there could be a selection bias there because they're talking to somebody that does what I do. But I think I've perceived at least there's a growing interest in in these kind of models due to um a little bit of a different work-life balance, especially at the early phase of the career. So I think it'll be interesting to see what happens. Um I think there's a lot of different trajectories that it could go, but I I definitely think we're gonna see some continued growth in the kind of the interdisciplinary large healthcare systems bringing chiropractors into the fold.

SPEAKER_01 10:31

So we'll have students listening to this, and obviously some of those students are interested in working with a medical establishment similar to what you have got going on. What are the qualities that you're looking for when it comes to hiring someone to join your team?

SPEAKER_00 10:47

So, what I always tell people is, you know, when, you know, for instance, when we hire, we just hired our fifth faculty chiropractor in July, right? We got a large volume of applicants, right? And so what I tell people is that there has to be something on your resume that sticks out because I'm not gonna call and have a 30-minute phone conversation with 100 people. So there has to be something on your resume that makes you stick out as saying, I am someone worth speaking to, right? That can be a lot of things. That can be, you know, that you showed that you were really involved in a student organization in school, that you got involved in research early, that you were a, you know, you were really involved with the student ACA, um, or you were uh, you know, for instance, students can become members of the North American Spine Society for free, but you've done sort of something beyond what is the bare minimum. And so you need something to kind of push that out. You know, for instance, the last time I don't currently lead our uh preceptor program, um, Dr. Jordan Gleat does. The last time I was in charge of it, the students who were applying to do their preceptorship with us, I joked with um Dr. Gleat. He and I were classmates in school, that their CVs were so impressive that if I had applied when I was at that same point in school, I wouldn't have even gotten asked for a phone call, right? So what we're seeing is these students are becoming incredibly impressive. I mean, you know, we had we had one applicant who had two peer-reviewed publications as the first author, and she hadn't even graduated chiropractic college yet. You know, we're seeing other people they're getting very involved in things beyond just the bare minimum of what's required to graduate, uh, which is really cool to see. You know, we're seeing people kind of, you know, they're they're very motivated, very driven. You know, we currently have uh um an intern right now who is uh incredibly pressive, very self-aware, inquisitive, you know, and so I think those are the things that I would really recommend. Like if a student wants to, you know, do those things to, you know, to get uh an internship at a place like ours or do one of the VA rotations, is you have to show something that shows you're you're involved in something greater than yourself. Because these positions get tons of applications. And you have to start finding a way of how do I go from a hundred to fifteen to have a phone conversation with, to then narrow that down to five that you do Zoom interviews with with the team to then vote on who you're gonna give an offer to. You know, and so those are the things, and that's kind of the same thing, you know, when we go through the process of hiring a faculty DC is you know, we have to kind of skim through, you know, and who's gonna who's gonna make it through that first wave. And there's you know, the ones that do, they always have something on their resume. They just kind of like a little bit of a shining light, like, hey, I've I've done something a little extra, you know, those are the things. I I don't think that it's necessarily any one thing, but showing that you have that capacity is is very important.

SPEAKER_01 13:45

Something along the line of research, possibly teaching. How how important is clinic experience?

SPEAKER_00 13:54

Yeah, so when we're hiring a faculty chiropractor, so we typically, you know, so we honestly we don't always take the most experienced person. Um you know, the the biggest thing that I think about when we're hiring someone is how is this person gonna fit into the team? Right. Because you can be the best clinician in the world, but if nobody in the workroom enjoys being around you, they're probably not gonna send you patients. Right. And so it we're all human beings, right? Um, and so the reality is you know, you you tend to engage more with people you enjoy, right? And so that's something where, you know, at least you know, you know, when we look at things, we may say, okay, you know, this person may have more experience, but this other person fits better with the team, and their experience is good, even though it's not, it hasn't been projected over the same length of time. Right. So I I'm not as worried about that. You know, when we met with our recruitment team for this last faculty hire, you know, they they said, What do you want? And I said, My number one priority is getting the right person. Who they are as a person matters more than anything else. Character. Yeah. Who who are you? Right. And um, you know, and that those kind of things are are incredibly important.

SPEAKER_01 15:14

Gotcha. So let's switch gears here a little bit. I know you enjoy teaching. Can you talk a little bit about how you started teaching and what you are currently teaching?

SPEAKER_00 15:23

Yeah, so that's morphed over time. I think the first time I did a formal, any sort of formal teaching was um was actually for the WCA 10 years ago, maybe. I I think I think it was shortly after John became the executive director. I think I spoke at a spring uh spring convention and gave a continuing education course on um on concussions. Um and I still do, as I've gone through my career, I I sort of do continuing education talks sort of in spurts and different things, um, which I enjoy doing. I think it's a good way to force yourself to learn, right? Because you don't want to go up and give a lecture that's outdated by a decade. You gotta you gotta work hard and you know do a lot of digging and deep diving through the literature to to put together a really high quality C lecture, in my opinion. So I enjoy that. It's now morphed into we've created more educational opportunities within MCW for our chiropractic team. So we bring in interns and clinical education is very fulfilling and walking these uh young clinicians through the process of you know developing a differential diagnosis, um, considering what team members may they want to co-manage a patient with and how do we place those referrals, how do we navigate the patient through this healthcare system? Um and then that's now morphed into coming up in July, we're actually going to launch um a postgraduate fellowship program here at MCW. And we're really, really excited and proud of that. We had to go through a lot of internal vetting as all new educational programs do, and we were able to get that accomplished. And we are we are all set to start taking applicants for our fellowship program on uh January one, and then we'll we'll go through the interview process and selection process, and we'll take our first fellow starting July 1 of 2024. And that I think it's it's been a lot of work, and I certainly have not done all of it. Um my colleagues specifically, Dr. Gleed, have done a tremendous amount of work um in building out our curriculum and evaluation process for the fellows. And I think that's gonna be a really exciting educational opportunity for our team, but then also for that fellow to come in and learn in a, as you pointed out, uh a fairly unique environment for a chiropractor. And so I think that's to date the most exciting educational thing that we've got going on. Certainly I still enjoy come, you know, giving some lectures here and there. And I think I'm you know, I'm set up to give one in North Dakota in April, and I did a webinar for Minnesota not too long ago. And I think the WCA has plans for me in the spring or something. So um I still enjoy that. But I think we're as my career goes on, I think kind of morphing that into you know these more formal, structured educational, you know, protracted educational opportunities is is really fulfilling where you get to spend, you know, in this case with our fellow, 12 months with this person, you know, providing continued education and sort of further developing those clinical skills after they graduate. And we're really, really excited about that.

SPEAKER_01 18:10

Speaking more to that fellowship, what makes an applicant an ideal candidate?

SPEAKER_00 18:16

So a lot of that same stuff we talked about before, right? What have you done? Right. So we're gonna have to pick you, uh pick you out of the pile, right? And so, you know, those kind of things. We see somebody who's, you know, maybe they're really engaged with a specific program through the school, uh, through their chiropractic college, and they've, you know, shown an ability to be, you know, to essentially do more. They or maybe they've been a president of something or they're engaged in this, or they've worked with the research program at their school to engage and help publish a case report, or they've been a member on a, you know, they've at least been a study member, or they've done chart reviews for a study, or you know, somebody who's really engaged in student ACA or NAS or just again, something that shows you've done more than the bare minimum. Because, you know, again, I always tell people like, think about the person who's going to be reviewing these applications. They're not just a chiropractor, right? They're also a spouse, they may be a parent, they may be, they have other demands on their life. And so help them to understand that you are someone worth talking to, right? Because that's what they're looking for as they go through that first screen of resumes, is I've got to screen through these and say, who do I want to talk to? Who am I maybe not going to talk to?

SPEAKER_01 19:34

Do you anticipate this fellow to be a student that is graduating, then moving into your fellowship, or is this someone that's an established chiropractor? Or it could be either.

SPEAKER_00 19:44

Could be either. So we've not placed a limitation on that. We can take, um, we will take, we could consider taking a practicing DC or someone who um who has just graduated from chiropractic college. We do have uh as a requirement that they have graduated by June 1 and that they have they have their NBC board done by that time as well. So we need because we need them to be able to apply for a license in the state of Wisconsin. So they need to have met all of those requirements, not by the time they apply, but 30 days prior to the fellowship starting.

SPEAKER_01 20:20

And they're physically on-site with you, not an online program. This is an on-site on the MCW campus.

SPEAKER_00 20:26

Yep. Yeah. So they'll be coming in. Um, that first bit of time will be spent, you know, essentially just orienting yourself to this kind of likely new clinical environment and what does this look like and uh familiarizing them with the electronic health record system, the clinic flow. And then at that point, they're going to start to become involved in the patient's clinical experience, you know, and that will obviously be kind of you know graded levels of autonomy. You know, initially the their the attending DC will be in the room with them for everything they do, including the you know, patient history. And then that'll go, you know, then transition to they can do a patient and history and exam without you in the room and come out and give a report of findings, and then you go in and as the attending confirm that, and then you know, then get to the point where they can do um some actual physical treatment under your direct supervision. And then the goal is by the end of the fellowship, is that the fellow will essentially have their own clinic. Wow, fantastic. And they're gonna be, you know, what does that look like and what does that feel like to have your own patient templates and seeing these patients and the attending is is, you know, they're not just sort of turned loose, they're still oversight by the attending, but that becomes less and less as they essentially prove their uh trustability. So we've developed a a program of of certain what we what are uh called entrustable professional acts. Um that's a a common term in postgraduate and undergraduate medical education and training. And um, as they progress and become proficient in those entrustable professional acts, then they will get more and more autonomy uh within the program. And then they will also do clinical rotations with other specialties, you know. Different specialties that are in spine care. We're also going to have them do uh clinical rotations in primary care, radiology, sports medicine. And then there's also an academic component. So there will be a requirement that they present so many essentially academic presentations. Um those can be both within MCW at maybe, you know, our annual spine day conference, or they may give a grand round lecture to the Department of Neurosurgery. They could give a didactic lecture to PMR, something like that. And then they're also expected to attend a certain number of academic lectures uh within Freighter and MCW. There is a small stipend for travel to a conference. There's some requirements around what we will approve and not approve. But um you know, and so there's going to be a strong academic component to this. If we get a very research-minded fellow and if we have a research project up and running that could they can meaningfully get involved in, then we can, then they will have that opportunity. And then after they've done the required rotations, then it becomes a little more flexible. We we go from set structured time, this is what you will be doing, to then it will be flexible time. If the fellow is saying, hey, I really enjoyed my time with radiology. Can I spend more time with radiology? We'll work to make that happen. So there's an initial set number of rotations they had they're gonna we're gonna have them do. And then after that, it becomes a little bit more flexible with input from the fellow about what have they found interesting to this point, and how can we kind of continue to craft this educational experience to be the as beneficial to them as possible?

SPEAKER_01 23:33

Sounds very powerful. Sounds awesome. All right. So, Jeff, you're a clinician, you're a teacher, you've been involved in a lot of research and now the development of the fellowship program. And I'm sure you're gonna be very involved once that fellowship program starts. What resources or strategies have you used for lifelong learning?

SPEAKER_00 23:56

Yeah, so I think it's find ways to get involved, right? So, you know, I've done various things. I've been involved in various WCA committees over my career. I've been involved in the North American Spine Society's evidence-based guideline development committee. I recently became chair-elect of the uh American Public Health Association chiropractic section. All of these provide opportunities for learning, right? Uh so the North American Spine Society Evidence-based guideline committee was one where you had to review something in the neighborhood of 400 abstracts for whatever your subcommittee was, right? So I was uh on the cost-effectiveness subcommittee. And so as a result of that, you end up learning a lot about cost effectiveness of care because you have to review four to 500 abstracts for this. And then you, you know, you go through different meetings, you know, zoom in in person to work with your subcommittee to then distill this down to ultimately what is the guideline recommendation. And so you get to rub shoulders with a lot of people who are cost effective, in my case, cost effectiveness experts, which I which I am not, right? But I got to learn a lot by going through that process. These associations, no matter how big they are, and I don't have to tell you this as the president of an association, associations need people to put in work, whatever that may be, right? And so, you know, finding ways to get involved is a good way to learn. You're gonna learn something because there's gonna be a need, and you're gonna end up learning something through that. And so those are the ways that I have found to really push myself to do and learn more. You know, there's also just a lot of different opportunities. I'm currently just getting my feet wet, taking some classes in in medical informatics. I'm considering committing myself to potentially do the entire series of courses and then uh take a certification test to become a fellow of the uh of that association. And that's kind of was just driven by my department needed someone to be a provider informaticist. So I became a provider builder for Epic to fulfill that need, and now I'm a provider informaticist, and now through that there was this opportunity to take these courses. And I was like, well, that's medical informatics is interesting. Um for those who don't know, it's essentially how do you take large healthcare data and distill that down to then improve the patient experience and the provider experience. And so when I graduated school 12 years ago, was was that my plan? No, but it was an interesting opportunity that presented itself, and I'm now learning a great deal, you know, through that process. So I think the common thread there would be, I think, be prepared to take advantage of opportunities that present themselves. You're never quite as busy as you think you are. I have found in my life, if I reflect back on the prior stage of life, I thought I was really busy. Right. And then I've learned, oh, I wasn't because I've managed now to fit this much more into my life without sacrificing other things. So I probably had more wasted time in there than I was realizing, right? I can agree with you 100%. And so what I've found is you're probably not quite as busy as you think you are. For me, my wife is a wonderful government, she kind of governs that for me. She kind of will let me know, and maybe I've letting that plate overflow a little bit. And she'll kind of like, hey, I think maybe you need to find a way to cut something back. Um, and I kind of use that as like a as a litmus test. If she's not frustrated with me by how much I'm taking on, then I'm probably at a sweet spot. You know, so I think there's usually more room and time to do things than you think there are.

SPEAKER_01 27:33

Yeah, and when I was agreeing with you 100%, I was actually reflecting on my own life. So just to get clear there, Jeff, yeah, you can just take an example like exercise. So I like to use the motto that emotion follows action. So I'll emotionally feel a lot better about something that I already put into action. So just get the action stuff going and the emotional follow after. And the same thing with routines. If I exercise when I felt like it, or if I just set it into my routine, then it's going to be a lot more consistent. So and then just the stuff that you were wasting time on just kind of falls off, right? Yeah, absolutely. So moving on, is there someone or something that was a large influence on making you who you are today?

SPEAKER_00 28:22

Yeah, I mean, I think there were many. You know, I go back, um I played a lot of football in high school and I played a bit in college. I mean, one of my high school football coaches is a very motivating figure for me. He was a biology teacher. You know, he was probably a very driving force into the idea that acad academics are not optional for athletes and really pushed that a lot. You know, and I had the either fortune or misfortune of having two older siblings who um were uh were very academically gifted, and so they were not going to he held me to that standard, right? If if your brother can do it, then you can do it. And that was you know, that was at times I didn't love it, but it was good. And then um as I transitioned, you know, through my undergraduate programs and then into chiropractic college, uh, I was fortunate, you know, uh while I was in school, I developed a relationship with the director of radiology at Logan, Dr. Norman Kettner. And uh for those who are unaware of Dr. Kettner's work in our field, I personally feel that we all owe him a debt of gratitude. He was the first chiropractor to become engaged with Harvard from a research standpoint. He is by and large uh one of one of, if not the driving factor for the fact that there's actually a funded PhD fellowship program in neurosciences that is jointly funded both by the chiropractic profession and Harvard University. He's published more case reports than any chiropractor in the world. And that was interestingly enough, another kind of early to mid-career chiropractic researcher actually uh did a tremendous amount of work and actually published a paper on that. And uh Dr. Kettner has published more case reports than anyone. And Dr. Kettner will push you outside of your comfort zone. I've always said, you know, Dr. Kettner has a way of not asking you to do something, but simply informing you of what he needs of you, and doesn't really leave an opportunity for you to decline, but in a very caring way and in ways that only push you to do more in ways that are good for you, right? So this was probably six years ago. He called me up and he said, Hey Jeff, I need you to come present at the um Academy of Pain Science. And I Dr. Kettner was very involved in that. And I said, I said, uh I said, okay, Norman. I said, you know, what do you mean to do? He said, I need you to present on a panel of people on um effective management of chronic pain disorders. And I said, Norman, I said, I I do that clinically. I said, but I don't, that's not my area of research. I said, I you know, there's probably other people maybe that could that could do a better job of this. And Norman is the only person in my life that calls me Jeffrey. And he simply responded and he said, Jeffrey, if I had wanted someone else to do it, I would have called them. All right. How do you say no to that? Right. And so I found myself then presenting on a stage with people from Harvard and Stanford and all these very prestigious institutions. And I uh definitely had a great deal of imposter syndrome going on, but Norman felt that I could do it, and so he pushed me to do it, you know, and and that has been a very impactful mentorship, mentee relationship that I've been fortunate enough to have over my career. And then the other one would be uh Dr. Will Evans, who's a DC PhD. Dr. Evans is um a really fascinating guy. He's a second or third generation chiropractor. When he was in practice, he practiced in rural Alabama, and he he told me at the time he was the only chiropractor in his county uh because it was just that rural. And um, he then left after a successful career in private practice, sold his practice, and got a PhD in health promotion. Uh, and he now is the, I believe I'm gonna get this correct, the dean of health sciences at Georgia State College University. And Will is a guy who will similarly, you know, push you to do things that are in your best interest and push you outside of that comfort zone with reassurance and guidance. Um, but you know, he'll, you know, he's the reason that I put my name in the hat to potentially become chair-elect for the American Public Health Association chiropractic section. And so I've been really fortunate to have some really strong mentors in my career that are unaccepting of complacency.

SPEAKER_01 32:48

You know, that's pretty crazy if you break that down because you've got those mentors that you learn from, and then they push you to push you, like you said, out of your comfort zone, which then proves to yourself that you've done that, and then what are you capable of moving forward?

SPEAKER_00 33:07

Right. You know, that's that's the thing, you know, and it's kind of this idea of like, well, what can you do next and how can you push? And you know, essentially, are your ideas big enough?

SPEAKER_02 33:16

Right? Yes.

SPEAKER_00 33:18

Why only do that? Why not do more? Why not push that more? Is that idea as big as it could be? Yeah. You know, and I've I've been fortunate enough to also have you know similar things internally at MCW with our current department chair, you know, Dr. Kirpad, and our director of community neurosurgery uh and chief transform transformation officer, uh Dr. Wong, you know, will put me in positions to assume leadership roles, and I'll say, like, am I, you know, sometimes I'll question, Am I am I the person for this? And their response is like, Well, I wouldn't be speaking to you if I didn't think you were the person for this. You know, and they'll kind of push you to do more, you know. And that's how, for instance, our annual spine day conference went. We'd held a concussion research day from our concussion research team, and I said, Why don't we have a spine day? And the response was, all right, Jeff, go make a spine day. Okay, very cool.

SPEAKER_01 34:06

And they weren't gonna let that slide. Hello, everyone. I want to tell you a little bit about the Wisconsin Carpenter Association 2024 spring convention. It's April 11th through the 14th, and it's gonna be at the Octoff Resort in Elkhart Lake, Wisconsin. Whether you're a seasoned professional or just starting out to practice, the spring convention is a place to be, join us for unique opportunities to earn seed credits for joining the beautiful surroundings of El Cart Lake. We have informative sessions with our industry experts. The vending area will provide the opportunity for units for a variety of products and services from these companies. And as you know, the end personal experience of the state convention always provides the opportunity products from the process. So again, April 11th to the 14th, Al-Cart Lake, Wisconsin, WCA Spring Convention, or the WCA website to register, can stay there. I want to go back to something you said earlier when you were asked to speak on the effective management of pain disorders. So now we're getting into the clinical area. What do you think are some of the most important tools that a chiropractor should have in their toolbox?

SPEAKER_00 35:16

So I think that um I firmly believe that why chiropractors see as much success as we do has a little bit less to do with what we do to the patient and a lot more to do with how we tend to build relationships with our patients. Right. We tend to, and I think we see this with physical therapists as well, right? We're seeing them more frequently, um, you know, whatever that frequency may be, once a week, a couple times a week, you know, and they're in that acute care phase. And so as a bypart of that, you're building a lot of you get to know this person a bit, right? Get to know them maybe more than you know some of our other healthcare provider colleagues, where they only get the opportunity to engage with this person once every six weeks, 12 weeks, whatever that may be. Um, and so I think becoming a really effective communicator and a genuine communicator with your patients. And that doesn't mean you know having a script that you use. You know, I always tell whenever we have learners with us, you can't be me, so don't try to be me. It's not to say that I'm better than you. We're just we're different people. The way that I communicate may not work for you because if that's not how you genuinely communicate, that's fine. I think that that that is the ability to build relationships and trust is the number one thing that you can build as a as a any sort of healthcare provider. Because patients know if you don't, if you're not being genuine with them, they have that third sense. Everybody does. I think that is like the number one skill set that someone can develop. And then clinically, yes, you have to be competent with your hands. That's that's a given, right? But you have that communication style. And one thing that I am of like a very strong believer in is providing messages of reassurance to your patients, right? Don't overamplify benign image findings. You know, don't I one thing that I always I try and say as frequently as possible on a first visit, so long as it's you know clinically true, is you know, there's a lot more good about your exam than bad about your exam, right? Right. You know, and constantly reminding patients like, hey, the odds are in your favor.

unknown 37:31

Right.

SPEAKER_00 37:32

Most people get better, right? Yes. It's my job to help you get there and give you some sound advice. But one way or another, statistically, you're gonna get better. And kind of providing these constant messages of reassurance, I think is it's worked well for me, but I think it's an opportunity to really grow that communication style and build like strong trust with your patients, right? I think that's you know, you you've been doing this longer than than I have, but I think clinically, I think that's a key, right? You know, if I get the choice between a patient liking me or trusting me, I'd rather them trust me.

SPEAKER_01 38:06

You know, your answer is really interesting because the last couple of guests that we've had on the podcast, one of the answers was listening to your patients, so that speaks to the communication that you just mentioned. The other answer was your adjusting skills, so that speaks to the hands that you just mentioned. But what I find really intriguing, what you just mentioned, was the reassurance part. And I can give you a personal example. I was on vacation in Florida about a year ago, and I'm not someone that's really dealt with a whole lot of lower back pain in my life. I got into chiropractic because of a knee injury back in high school. So I've never been that acute lower back pain patient until about a year ago. I'm down in Florida, I'm reaching for some shoes, and I throw my back up, so to speak. All right. So I'm now in an acute lymphoset syndrome that was unbelievably painful. I was pretty much bed-ready. And my wife, who is the caregiver in the family, the truth caregiver in the family, she uh said, I'm scheduling with a chiropractor down here. And I'm like, who am I gonna go to? So she looked up a resource and a chiropractor just so happens to be she's 76 years old, been in practice for 50 years, and visited him. And here I am with this 90 killer back, and he took a couple of things of my back. And I don't know if he just sensed that I was just indirect in my brain because I better just put it in the eye and said enough, you're gonna get better. I know what's wrong with you, you're going to get better. And this tremendous sense of reassurance is always in over me as someone who's been in practice for over 30 years myself. But that whole reassurance, we don't think we get a patient that just comes back to us and says, Yeah, I went to my doctor and they said they figured out my problems. I've got arthritis in my back. And I always kind of just negated that as, well, of course you've got arthritis in your back. We all know that you've got arthritis in your back. But that doctor gave them some reassurance that they knew what was wrong with them. You know, it was maybe not specific reassurance, but it was reassurance. So your point is well taken.

SPEAKER_00 40:19

Yeah, I mean, knowledge is power. Um, I've dealt with intermittent ridicular symptoms for 15 years, probably since playing football in college. And every time I get a big flare-up, right, uh, you know, I should know better than anybody, right? But every time I have a nasty flare-up, I in the back of my head, I'm like, is this the time? Is this the time where I'm gonna have to have surgery? Right. And I should know better than like statistically, it's unlikely, right? But it doesn't stop that worry from setting in, you know, and so I think that we we need to be mindful that fine pain in general is inherently scary to people, right? Because everybody has a coworker or an uncle or a grandpa that, you know, they've had back pain forever and nothing's ever worked, and they've tried everything and they're just stuck and they they don't function. And I think a lot of people then get that sense of is that like, is am I next? Right. And I think that that that consistent reassurance is is a really powerful tool and strategy to help our patients get better. Fantastic.

SPEAKER_01 41:20

Oh, and by the way, the happy ending to my story is I saw this chiropractor three days in a row and I flew home 100% pain-free on that fourth day. And so Dr. John Kellenberger in Fort Myers, Florida. I owe you one big time. I'm actually going out to lunch with him next week when I'm down there in Florida. So moving on. What keeps you passionate, Jeff?

SPEAKER_00 41:44

Um, I think it's it's you know, it's a lot of things. I think um, you know, I I have I'm very fortunate to have a lot of of resources available to me. And so I feel a bit of an obligation to take advantage of them, right? So my research keeps me passionate. I think that that's very engaging. Patient care keeps me passionate. I I unfortunately I still very much enjoy being in the room with the patients. I think those are the two big drivers. You know, I think the administrative work that I do is is interesting and engaging, uh, you know, and getting to kind of you know be involved in the process and choosing, you know, what levers and switches are we going to implement to try and affect how things happen across our healthcare system is is really interesting. I, you know, I think again, I get back to that idea of variety a lot. I think that the variety of different things I get to be involved with keep me passionate because I don't I don't have to just focus all of my energy into one thing. I get to kind of keep that up, which then keeps me sort of engaged. And you know, I may get I may get one research project sort of finished and then I can sh I shift focus and I work on something else for a while, a big project that I need to prioritize. And then I get, you know, I have a little bit more time, so then I'll come back and I'll get to refocus energy on my research again. Um and the one constant there is of course the you know the patient care that that doesn't ebb and flow. But I think that those other strategies and things that I get to use to stimulate myself is is is what keeps me keeps me going and keep me passionate. And I'm fortunate that I I get to have a lot of fun at work. You know, everybody has bad days at work, you know, not not the world's not you know, rainbows and puppy dogs, but I've got a lot more good than bad. And I'm really fortunate with that. And I think that that kind of keeps me driven. You know, I'll some if I have a bad day, sometimes I'll I'll force myself to sit down and write down on a sheet of paper, well, whose job would I want? If not this one, whose? And and to be quite honest, I mean, I I don't I don't know who like I don't know that I could design a more perfect combination of things for me than what I've got. So it's it's a lot of it's interesting. I more often than not, the you know, the pen stays sitting on the table next to the sheet of paper, and then I kind of tell myself, well, then you know. Suck it up, move on, and get back to work.

SPEAKER_01 44:03

Well, speaking of having fun at work and in your environment, I'm sure there's a ton of collaboration. Do you have a collaboration moment that you can discuss?

SPEAKER_00 44:15

Yeah, I think there's a lot of them, right? I think the um, you know, I think the one that that comes to mind is kind of, you know, a thing that that happens sometimes. And and and I don't know if this never happened to me in my admittedly very brief time in the private practice world. But it happens a handful of, you know, at least a couple of times a year here, where a patient will come in and you know, patients don't always know what's wrong with them. Maybe they've had persistent neck pain for years, right? And they're having a particularly bad episode. And they they come in, we evaluate them, and then all of a sudden they're they're hyperreflexic and they've got diffuse upper motor neuron signs. And we say, I say, hey, we need to pause. I'm gonna get you an MRI, ASAP. I'm concerned about some spinal cord compression in your neck causing these symptoms. I'm gonna get you a stat MRI, and I'm gonna have you see a neurosurgeon, ASAP. And they'll kind of stare at me and they'll be like, Wow, you know, it's really? And I say, Yeah, we need we need to work this up. And when you can meaningfully take that patient and you say, There's something wrong here, but we have a plan. And because of this team we have, it's gonna be seamless for you, right? So I'm gonna take, we're gonna place some sort of we're gonna get you an MRI, and then you're gonna see the surgeon either that day or the next day, right? Because if you're myelopathic, if you have compression of your spinal cord, you know, that needs to be decompressed pretty quickly. And so when you can take these patients from exam with me to image to surgeon to surgery, to then a significant improvement in their quality of life, you know, it's not uncommon. Those people will be in the clinic for their post-op wound check and they'll see me in the hallway and they'll stop me and they'll say, Thank you so much. That meant so much to me. Thank you. Right? Got it. And that's really cool. But then the flip side of that is if you have a patient who's in really acute pain, they see the surgeon. The surgeon says, You don't, you don't need surgery right now. You don't want surgery right now. We're gonna have you see one of our chiropractic team members, and they may come to us and they say, Hey, can you sneak this person in today? And, you know, if we can, we will. And even if we kind of can't, we will. That patient goes from surgical appointment to chiropractic appointment that day, right? With little to no effort on their part. I may say, Hey, can you hang out in the lobby for 30 minutes and then we'll get you back in a room? And then you go through a course of care with that patient and they get to avoid a surgery, that's really powerful, right? And I think that that's the benefit of, in our scenario, having this sort of co-housed, co-mingled spine center where I don't even necessarily have to place a referral, right? And they don't have to wait for a phone call. If the surgeon's there that day, I'll just say, Hey, can you, is this good? Are you good with this? Can you see them? The MRI is scheduled for tomorrow at two, can you see them tomorrow at four? Yeah. Right. And they just leave with everything set up, right? Or conversely, they see the surgeon, hey, you know, we're gonna have you see uh, you know, Dr. King or Dr. Gleed or Dr. Whitcomb or Dr. Trotchell or Dr. Peterson right now or in an hour, right? And that's a really cool thing for a patient. I think they feel heard, they feel cared for, you know, and I think that's a really powerful thing for the patient, right? Um, no doubt. To kind of drive that and get a sense that, like, okay, like I'm I'm being taken care of here, right? The more extreme example is that, you know, right around Christmas time one year, we we I had the uh distinct displeasure of, you know, finding some um metastatic lung cancer in a patient. And because of the team we have, when I had to call her and deliver that news, I could say, you have an appointment with your primary care team tomorrow at four. You have an appointment with our chief of spine tumors tomorrow at two. You're gonna get a you're gonna get a CTA of your chest out of pelvis tomorrow at 11 before those appointments. And I'm really sorry that this is happening, but we've got a plan. Right. And you can call and you can just say, this is that plan, right? And again, I think that that is like, is it fun for me from a professional standpoint to collaborate with other providers? Absolutely. But I think the most powerful piece of that collaboration is for the patient. They understand that their healthcare providers are actually talking to one another, which is, I think, you know, the good and the bad of the electronic healthcare record is I don't know that healthcare providers pick up the phone and talk to each other as much as they did once upon a time. Right. And I think that giving patients that sense that they're being heard and that people are actually talking about how to best take care of them is a really, really powerful tool to help patients get better.

SPEAKER_01 49:17

Speaks back to your point on communication, not only with the patient, but with your collaborative other healthcare providers, and then back to the patient. And then you were instrumental in taking them to the level that they needed to get. Yeah. A couple more things, Jeff. Let's talk a little bit about the research that you're doing at MCW.

SPEAKER_00 49:36

Yeah, I I personally have a a couple of different sort of research interests that are all always kind of all running in parallel. So my my main primary interest is what is the interplay between cervical spine pain and and whiplash injury with concussion patients? And how does the presence of cervical spine pain following a concussion impact or not impact your recovery from that concussion? Right. So, you know, I um suffered a couple of concussions playing football in high school and college, and um personally have an interest in it. And then clinically, you know, when I when I was early on here at MCW, I had the really strong fortune to build a relationship with the head of our headache clinic. We both happened to come at MCW at the same time. So we actually met at a new faculty orientation. And his name's Dr. Fred Freitag. He's since retired, but he is a he's always practiced headache medicine, his entire career, and he happens to be a DO by training. And we met at the orientation, and you of course had to do the standard everybody introduce yourself spiel that we all we all dislike. But he came over at the first break and he introduced himself. He said, You're a chiropractor. And I said, I said, yeah, and he said that's really cool. I didn't know that we had chiropractor too. That's awesome. Can I send you patients? I said, Yeah, of course you can. Great, let's let's figure this out. And then he would see these people who'd been diagnosed with persistent concussion symptoms and these post-concussive headaches, and he would get them in the clinic and he would say, This isn't a post-concussive headache, this is a cervicogenic headache. I think you just had a whiplash injury, go see Jeff. And then we would treat these people and they would get better, and people would want to know, well, how are you treating their concussion? And I said, I don't think I am. I said, I think I'm just treating an undiagnosed, unmanaged whiplash injury that was producing concussion-like symptoms. But because they had a concussion, we were just labeling this as persistent concussion symptoms.

SPEAKER_01 51:28

Interesting.

SPEAKER_00 51:29

And so then we decided to say, well, we've got folks know it, right here in Wisconsin, uh, MCW, and even more beneficial for myself, the Department of Neurosurgery at MCW is one of the most well-funded concussion research centers in the country. And so we had, I had, I was, I was able to have access to then some research databases and start to look at this to say, how many people are even reporting neck pain after concussions, right? Because if it's 5%, we probably don't need to spend a ton of time researching this, right? Like, but it's actually pretty common. And so in the first paper we published, we found that at 45 days post-injury, about 30 to 40% of people were still reporting neck pain. And so then we went on, we've published a few more papers. And I I the manuscript I'm working on, well, I'm working on two manuscripts right now, but the one, the larger manuscript, is um I was able to get access to a very large NCAA concussion database. And the benefit of that paper is that it for the first time I will know did these people have neck pain before their concussion? Because prior to this, in my the research data I had, I never knew maybe they've had chronic neck pain for 20 years. But now, now I know we have the benefit of knowing did they have neck pain prior to this injury or not? And so we're going to be able to publish some pretty meaningful findings on both the frequency of neck pain in concussion, specifically whether it's new or worse neck pain, but then also do those people with newer worse than neck pain have a delayed recovery from their concussion?

SPEAKER_02 53:04

I see.

SPEAKER_00 53:05

It should hopefully be a pretty impactful paper in this area of research. And what's been really fascinating is you know, seven, eight years ago when I started down this line, nobody was looking at this relationship, right? And now it's sort of very interesting. There's probably seven or eight, maybe even ten people across the country who are now like very aware of this line of research. And there's a bunch of people now driving this forward. And I've had the opportunity to collaborate with researchers at the University of Pittsburgh, uh, the University of Texas, San Antonio, now, you know, potentially moving forward, some other people internationally on this on this um uh line of research. And it's really exciting stuff. Um newer line of research is you know, since I've been seeing patients at Children's Wisconsin, I was connected with a couple of uh DC PhD researchers, uh, one from Australia and one at Parker University. And we just submitted R01 NIH grants to actually longitudinally track what is the typical course of recovery for an adolescent with back pain. Because currently we have no data on this topic whatsoever. And so that's been a really cool thing to get to be involved in you know creating that grant submission and submitting that grant submission. And, you know, we'll we submitted it at the beginning of this month. So you know, we'll find out in May whether or not we get it. Um but it you know, it's a really cool it just speaks to again of I'm very fortunate to have access to resources. And so then through those resources, I was able to then collaborate with these other people to drive that forward. And then um, you know, the last sort of I'm more tangentially related to this, but we have a uh MRI physicist in our department, and he is really interested in looking at perfusion and diffusion rates across vertebral implates into discs and whether or not there's an association with that and ostery disability index scores. And so we've published uh one paper on that and actually, interestingly enough, did show a correlation, and so we're in the process of now recruiting subjects to further that that study with uh specific research MRIs and look at correlations there. And and then my my colleague, Dr. Gleet, is actively getting his PhD in public health while maintaining a full clinical practice and being the associate program director of our fellowship. And um, he does far more research than I do and has already suppressed me in every measure. And he will continue to grow and do more and more. He he's very interested in the interplay of social determinants of health on back pain. And I think his research career will far exceed mine and is already doing so. So we have that a really fortunate opportunity to to grow the research side of our footprint due to how much value our department places on research.

SPEAKER_01 55:48

Very cool. Well, we definitely appreciate everything you're doing in that area, and we will definitely stay tuned on your research results and everything you're doing going forward. So speaking to that, well, we'll have to have you back on a podcast for those results. I'm gonna ask you one more question before we close out. You've done a lot in relatively speaking, not a lot of time for all the AFCs. You're you're still a very young man. And you've already been awarded the Wisconsin Chiropractic Association chiropractor of the year. I believe that was in 2019. Yes. Do you have a proudest career achievement or milestone?

SPEAKER_00 56:30

You know, I I think it's um I think it's it's our fellowship. You know, it was it took a long time to get it going. And and um part of that was just delays due to due to COVID and educational institutions were not propping up new new educational programs during that time, during that time of uncertainty. But a lot of time, a lot of effort. And I my hope is that it's gonna be a meaningful impact beyond just our department and our institution. But my hope is that it can provide a blueprint for other academic uh medical centers that have chiropractors on a way to do a clinical training opportunity. The VA has done a tremendous, tremendous job. And I don't even know that we would have considered taking this project on if the VA hadn't already developed the footprint and the blueprint that they used to get going. Um, and we're seeing, you know, uh Aurora now has a residency program, and we're seeing more research and public health-based fellowships popping up at Harvard and Yale and Dartmouth, all very specific to involving chiropractors. You know, so my my hope is that that our fellowship will be another piece in that wall towards building something better for the profession, and then as a byproduct of that for the greater public um and improving our ability to care for their spine-related pain. Awesome. Any closing thoughts, Jeff? You know, just thanks for thanks for having me on. And, you know, um, you know, Chris, thank you for all the work that you do as the president of the WCA. And and I know that that is um that it is not a small amount of time or effort um that you you know fit into to you know running a very busy clinical practice and you know being a dedicated father and husband, and please know that that that effort is appreciated.

SPEAKER_01 58:19

Well, thank you for that, Jeff. And I'm sure you would agree with me that all the time that you give the profession, you would, like I said, probably agree. We get back even more, don't we?

SPEAKER_00 58:29

Yeah, absolutely. But um, you know, it's it's you know, I I I made a comment I was sitting on a national um little think tank panel uh the other day. And you know, one of the things I I boys was you know, my concern is that when I do these things, it's the same 10 people every time showing up that are answering the call. And so, you know, I think my hope is that people you know hearing that message from you, that that time invested comes back easily twofold in other benefits to you, will encourage other people, you know, to step up and get involved because you know that's what it takes. And that's not unique to our profession. That's all professions. Um you know, and I I hear that from you know surgeons and everything else. They say, Yeah, all you know, all these various different committees are essentially the same 15 to 20 people. Yeah, right.

SPEAKER_01 59:20

I just get to sit back and listen to all these successful chiropractors, so time will spend. So yeah. All right, Jeff. Well, to those of you listening out there, that is Dr. Jeff King, chiropractor, director of chiropractic, associate professor for medical college of Wisconsin in the Department of Neural Surgery and Spine Care. He's a clinician, he's a teacher, he's a researcher, he's a developer of the fellowship program at the Medical College of Wisconsin. Jeff, I want to thank you for everything you do for chiropractic and within your profession. Thank you very much. Thank you, Chris.