Education – The American Chiropractor

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New York Chiropractic College: Helping Pave the Way for 21st Century Nutrition

by Mary E. Balliett

New York Chiropractic College (NYCC) now offers a nutrition program structured to prepare graduates for a wide range of clinical, consulting and industry settings, emphasizing an integrative approach to healthcare aimed at providing a professionally oriented curriculum.
The new 36-credit hour six-trimester program focuses on clinical nutrition and its application in prevention and disease management. Graduates will be able to design intervention programs encompassing diet, exercise, and nutritional supplementation, well suited for private practitioners, integrative practice, and consultant roles with research and industry.

Coursework is designed for working health professionals and is delivered one weekend per month through NYCC’s interactive video teleconferencing system located in Levittown, NY, Seneca Falls, NY and DePew, NY, and is supplemented with online computer modules. Course delivery in three locations by highly accredited faculty with clinical research experience allows students to interact with instructors and other students at least once per term.
For more information call 1-800-234-6922, or visit www.nycc.edu.

An Interview with Mark Zeigler, D.C., President, Northwestern Health Sciences University Building New Models of Health Care

Mark Zeigler, D.C., has been the President of Northwestern Health Sciences University since 2006. After graduating from Northwestern College of Chiropractic in 1980, Dr. Zeigler established a private practice in Sturgis, South Dakota. Along with managing a busy chiropractic practice, Dr. Zeigler served as a City Council member in Sturgis from 1982-1996, and as Mayor of Sturgis from 2001-2006.

Dr. Zeigler was appointed to the South Dakota Governor’s Health Care Task Force on Managed Care in July 1995 and was appointed to the Governor’s Public Health Advisory Committee in May 1997. Dr. Zeigler served as president of the South Dakota Chiropractic Association from 1994-1996 and was the South Dakota delegate to the American Chiropractic Association from 1998-2006. Additionally, Dr. Zeigler was named the South Dakota Chiropractors Association Chiropractor of the Year in 1998, and was named the Alumnus of the Year by Northwestern Health Sciences University in 2002. He served on Northwestern’s Board of Trustees from 1996-2006, and was the Board chair from 2004-2006.

Dr. Zeigler and his wife Gae have three adult children, Gabriel, Miaken, and Jonathan. The American Chiropractor (TAC) caught up with Dr. Zeigler (Zeigler) to discuss Northwestern’s role in the educational discipline.

TAC: Dr. Zeigler, can you tell our readers some of the exciting things that Northwestern has been experiencing?

Zeigler: Let me begin my answer by first thanking The American Chiropractor magazine for giving me this opportunity to tell the chiropractic world about the exciting initiatives currently underway at Northwestern and the goals we have accomplished recently. Obviously, the progress on our “Imagine Our Future” Capital Campaign has been a main reason for many of our accomplishments. Our new 48,000-square-foot addition, the Wolfe-Harris Center for Excellence, was a direct result of the campaign, as was the Standard Process Healing Garden; the Integrity Management Student, Alumni and Career Services Center; and the Foot Levelers Bookstore. Extensive renovations to many of our existing classrooms, including the CDI Radiology Lab and the Integrity Management Smart Center, were also linked to fundraising efforts as part of the Capital Campaign. All of those additions and enhancements to the “bricks and mortar” of our University have provided us with the physical facilities we need to achieve our goal of being the university of choice in natural and integrative health care. Now our job is to provide our students with the educational curriculum they need to succeed as practitioners in a 21st Century health care environment that is rapidly evolving. And that is something we are spending a great deal of effort on enhancing.

TAC: What are you doing to create better educational content?

Zeigler: We believe that it is imperative that we prepare our students for the realities of the emerging health care marketplace, and that we provide them with the tools and clinical models that will help them succeed. With that in mind, we have pushed aggressively in the last several years to develop clinical training models of health care that are evidence-informed, patient-centered, and integrative in nature. And those models need to focus that care on a diverse patient population that mirrors changes in the American demographic landscape. To accomplish that goal, we have reached into diverse communities and to at-risk populations throughout the Twin Cities by providing natural health care in conjunction with respected social service agencies. We have established and successfully grown clinical models that include multiple modalities, ranging from chiropractors to healing touch practitioners. We have implemented an extensive research-focused segment into our curriculum. We are working on establishing a joint clinic with a major medical health care provider in the Twin Cities as a model of how natural and allopathic practitioners can work together. And we continue to look at ways to create even better learning partnerships among the many programs we have on campus. Remember, we were the first natural health care educational institution to pioneer a true university with multiple degree and certificate programs. So we have been working for more than a decade at developing new models of health care delivery. And we intend to continue to be a national leader in this area for the decades ahead.

TAC: How does all of this impact the individual chiropractic student?

Zeigler: Obviously, the better we prepare a student to have the skills necessary to thrive in the health care marketplace, the better we have done our job. But learning is not just memorizing material. Much of what we teach our students is to make choices, based on the knowledge they have learned. So, if you expose a student to a variety of clinical models, and a variety of patient populations, you create a very adaptable future practitioner. If they feel comfortable working with an acupuncturist and a medical doctor, it opens up a whole new world of clinical opportunities for them when they get into practice. The same can be said of our approach to technique classes. Our intent is to provide our students with a deep foundation in adjusting, and then give them access to a broad array of techniques through clubs. By providing choices and access to all of these different disciplines, patients and techniques, we allow each of our students to build a future in health care that mirrors their passion and skills. In that process, we graduate the best doctors possible.

Visit www.nwhealth.edu or call 1-952-888-4777 for more information.

Personal Trainers Have It Right: Proper Actions, Executed Consistently, Bring the Best Results

Some practice problems stand out where you can see them; others are subtle, like a low-level pain that comes and goes.

Common ones faced by chiropractors include:

• Financial underperformance

• Persistent claim denials

• Potential for audits and payback demands

• Excessive time per visit

• Inefficient office processes

• Slow practice growth.

If you suspect that your clinic needs help and you don’t take measures to identify the issues, they are never going to get fixed and you’ll just keep living with the negative impact. The following brief examples recount outcomes experienced quickly by three doctors who decided to act.

Each case entailed an on-site visit to the practice by a consultant who performed a thorough practice analysis, identified problem areas and suggested action plans to address specific needs. Along with the initial corrective “adjustments,” extended relationships were established that include regularly scheduled calls to review progress and update the action plans, to identify and work towards milestones, and to confirm that new coding and document practices introduced to the practice remain compliant while maximizing revenue per patient visit.

It’s a lot like engaging a personal trainer to get your body in shape….

Compliance

Starting her career as a registered nurse, Dr. Deb Skrzynecki shifted to chiropractic following successful treatment for a back injury that she suffered in her work. She attended Palmer College of Chiropractic in Davenport, Iowa, spent 17 years in a multi-doctor practice following graduation and, in 2000, opened Skrzynecki Chiropractic in Toledo, Ohio, with one assistant.

Dr. Deb stayed away from coaches, she says, because she didn’t want anybody telling her how to deal with patients and how to run her practice. Nevertheless, with her extensive medical and chiropractic background, she became concerned about compliance issues in the increasingly complex healthcare environment.

She selected a consultant that she encountered at a continuing education seminar, impressed by the breadth of coding and documentation knowledge on display as well as the strength of commitment to the chiropractic profession. She worked out the issues she wanted to deal with over the phone, after which the consultant arrived at the office to address them. The main objectives:

• Better, more direct documentation

• Identifying overlooked billing opportunities

• More effective collection procedures

• Increasing revenue without increasing patient load

• Smoother patient flow.

With these objectives in mind, the consultant arrived on site to perform a comprehensive analysis of her coding and documentation procedures and business practices and to devise a near-term, mid-term and long-term plan of action. Currently, she is executing that plan, secure in her compliance plan, and already experiencing results that will ultimately generate the time and resources to allow her to pursue her eleemosynary interests: establishing a holistic women’s health center, and providing chiropractic help to the working poor.

Examining the Practice, Close Up

Classmates Dr. Nathan Sikora and Dr. Michael James opened their Center for Holistic Medicine in East Liverpool, Ohio, in 2005, following their graduations from New York Chiropractic College. True to the name they chose, they offer a full range of services to all types of patients, from no-pain/wellness programs to severe pain cases, averaging about 30 per day.

The doctors used a number of coaches since the practice debut, most of which focused on getting more patients or bettering the patient retention rate. All operated remotely and, while they seemed effective in their respective areas of focus, none addressed the basic practice problems:

• Inefficient systems and poorly defined personnel responsibilities

• Communications with patients and staff

• Better communication with insurers, including more effective documentation

• How to increase per-patient revenue without squeezing the people

• How to establish a program for positive growth.

Dr. Nathan established a relationship with a consulting group following his attendance at a seminar, at which he was impressed with the way in which the consultants view the profession and its issues. He was particularly taken with the approach in which consultants would actually visit a practice, perform hands-on analyses of its policies and procedures; identify what was being done right and what was wrong; execute a probing examination of coding and document practices; and develop a treatment plan.

“In the on-site visit, the consultant was able to examine up-close what we were doing in detail and show us how to make changes quickly,” Dr. Sikora says. “We saw positive results almost immediately and we have an ongoing relationship for supporting our continuing success.”

I can get paid for that?

Dr. April Macary opened a practice in Columbus, N.C., in 2004, subsequently moving her primary location to Ashville, while maintaining the initial office as a satellite. Currently, she practices both as Awakening Heart and as Macary Family Chiropractic, and there is a special emphasis on family: a large component of her patient load is comprised of pregnant mothers coping with the back strains typical of gestational progression. Not surprisingly, she works with many children as well and, by design, with very few Personal Injury cases.

Only three years out of Sherman College of Chiropractic, Dr. April centralized her activities in Asheville in 2007. Seeing about 30 patients per day allowed her time to analyze her efforts and she quickly concluded that she was not coding all that she should, and that, not infrequently, she was not coding correctly on certain treatments that she did bill.

A former classmate of the doctor had joined a consulting group and, through this connection, she set up a relationship that commenced with an on-site visit to her practice. During that visit, the classmate-now-consultant performed a detailed analysis of her business processes and coding practices. A number of problems emerged:

• Inefficient procedures and forms were being used throughout the offices

• Confusion about codes and their application

• Lack of confidence led to missed revenue opportunities

• Too many instances of incorrect coding of treatment

• Potential areas for denial/audit/payback risk.

In the on-site visit, heavy emphasis was placed on how to apply the billing codes in documenting treatment for full, fair compensation. Dr. Macary now codes with confidence and, with the help of her consultant, she is currently revising all of the forms in her office to achieve greater clarity, better workflow and more effective management.

She spends more time with each patient because her documentation is more streamlined, reducing the amount of time devoted to paperwork. Practice revenue increased as she began coding and billing fully and fairly for all of the treatment she provided on each patient visit.

“In school we learned to heal,” she says. “We were not taught how to operate a business but, to be successful, you have to be businesslike as well as professional.”

Personal training for clinics?

So your practice consultant can, indeed, be likened to a skilled personal trainer that you retain to whip your body into top physical condition. Think of these resemblances:

• Each engagement is unique, so each training program is unique.

• The best program is set up for the long term to provide motivation, guidance and support.

• Workflow is organized to accomplish more in the same amount of time and to maximize effect versus effort. (Think same schedule, more patients, and more revenue per patient visit.)

• Strong, healthy practices (bodies) with minimal risk of denials or audits (injuries) derive from consistently performing each activity in the right way.

• Like disciplined physical training, proper coding and documentation builds the strength and endurance your practice needs to prevail and profit.

Contact Bharon Hoag at 1-866-286-5315, ext. 604; email [email protected]; or visit www.acomhealth.com.

Supplemental Programs Offer Invaluable Training for TCC’s Interns

Texas Chiropractic College’s Supplemental Training programs have become an invaluable extension of the college’s curriculum. Interns in their final trimester are eligible to participate in the Hospital Rotation Program or in the Preceptorship Program. Following graduation and before becoming licensed, they have the opportunity to add to their education through the Postceptorship Program.

Hospital Rotation Program

The most recognizable of these is the Hospital Rotation Program. Established in 1985, this one-month program allows for observational clinical and surgical rotations in the fi elds of orthopedic surgery, neurosurgery, reconstructive surgery, sports medicine, rheumatology, pain anagement, pediatrics, internal medicine, family medicine and radiology. Texas Chiropractic College has drawn national attention as the “Texas Model” for this off-campus educational experience.

One of the primary goals of the hospital rotation is to promote and establish dialogue between those in the medical professions and chiropractic interns. The exchange of information on diagnosis, treatment and research opens avenues of understanding and appreciation between the professions.

Interns realize numerous benefi ts from participation in a hospital rotation. Their exposure to a comprehensive healthcare approach of treating patients gives them a better understanding of chiropractic’s contribution to the healthcare system in this country. In observing medical and surgical procedures, the interns become aware of alternative care that is beyond the scope of chiropractic care. Their exposure to a variety of patients and conditions as they work with medical personnel enhances their diagnostic abilities while, at the same time, the interns become familiar with proper hospital protocol and interdisciplinary dialogue.

There are approximately twenty different rotations located throughout southeast Texas. In addition to the clinical settings, the Texas Medical Center, the University of Texas Medical Branch–Galveston, and the Veterans Affairs Medical Center, both in Houston and Temple, TX, have established hospital rotations agreements with Texas Chiropractic College. According to Colman Albracht, D.C., TCC’s Manager of Supplemental Programs, the college’s interns are well received. Their sound preparation in the basic sciences is evident as they interact with medical students and doctors, and Dr. Albracht has heard many favorable comments from the participating doctors in the rotations.

Preceptorship Program

Texas Chiropractic College’s Preceptorship Program is actually comprised of three different programs. Preceptorship I is a locally based program that allows an intern to spend a full week in fi ve different practice settings. While the intern is completing the clinical requirements in the Moody Health Center, he or she can devote fi fteen hours each week to the program while spending fi ve hours in the clinic. Once the clinic requirements are completed, the intern spends twenty hours per week in Preceptorship I. The program is observational only.

Once the requirements for the Doctor of Chiropractic Degree Program are completed, an intern can participate in Preceptorship II, spending fi ve weeks with a participating field doctor in either the United States or Canada. It is a ywenty-hour per week commitment. The intern observes and, under the direct supervision of the participating doctor, can perform exams and use some modalities such as ultrasound, traction, moist heat, interferential or electrical stimulation.

Preceptorship III provides the most extensive experience of the three programs. An intern may spend the entire trimester, fifteen weeks, with a participating fi eld doctor in the United States or Canada. Before entering the program, the intern must have completed all of the college’s requirements to graduate and have passed Parts I and II of the National Board exams. The intern will spend a minimum of thirty hours per week in the program, which includes all aspects of patient care, including manipulation under direct supervision of the doctor. However, students are not allowed to formulate a diagnosis or treatment plan.

Interns spend approximately 80 percent of their time in the clinic and 20 percent of their time learning the business side of the practice. It’s about as close to being in actual practice as an intern can get on this side of graduation.

Postceptorship Program

In the fall of 1999, Texas Chiropractic College inaugurated a Postceptorship Program. This somewhat novel one-credithour post graduation program allows graduated students to enroll for a postgraduate class that carries the same general requirements, benefi ts, and regulations as the Preceptorship III Program. Graduates continue to develop their skills and gain valuable experience while waiting to receive full licensure.

In Conclusion

The purpose of the Texas Chiropractic College Supplemental Training Program is to augment the Doctor of Chiropractic Program by providing voluntary opportunities of off-campus training experiences to interns who qualify, under the supervision of qualifi ed doctors, both in the field of chiropractic and various medical fi elds.

Interns who have completed the Hospital Rotation Program, a Preceptorship and/or Postceptorship Program have been enriched in many ways by their experiences. They leave Texas Chiropractic College well prepared to take their place in the healthcare system of this country as Doctors of Chiropractic.

Visit www.txchiro.edu or call 281-487-1170.

New York Chiropractic College: Helping Pave the Way for 21st Century Nutrition

The new 36-credit hour six-trimester program focuses on clinical nutrition and its application in prevention and disease management. Graduates will be able to design intervention programs encompassing diet, exercise, and nutritional supplementation, well suited for private practitioners, integrative practice, and consultant roles with research and industry.

For more information call 1-800-234-6922, or visit www.nycc.edu.

Warning; College May Be Harmful to Your Financial Health

I have had the opportunity to visit quite a few of the chiropractic colleges throughout the United States. I have seen large campuses and small campuses. I have seen colleges in the South, North, East, and West; in cold climates and in warm climates; campuses that are straight and some that are more medically oriented. Quite a variety. There is one thing that I find that they all have in common. By the time students graduate, they are usually not very happy with the quality of their education and they are not happy with the professors. In fact, they are not happy at all! Why, you ask? Well, if you are a chiropractic graduate, you know why.

When you first enter an undergraduate college as a freshman, you are the lowest form of animal life on the face of the earth. You look forward to the day when you will be a “BMOC,” big man on campus—a senior. (I am probably dating myself with that last statement!)

When students consider becoming chiropractors, it is a different ballgame. They are told that they will be doctors and that everyone will look up to them. They should not concern themselves with financial matters concerning tuition. They will get student loans, which will cover everything. They enter chiropractic college, not as lowly freshmen, but touted as future savers-of-lives!

About half way through their education, suggestions are made that maybe they should consider reducing the amount of their student loans. Sometimes they are told that they may never be able to make enough to pay off their loans. Now the pressure is on. The cost of their education has probably increased on a regular basis and the amount of their loans has not. What is a student supposed to do?

To make things even worse, they enter the clinics and, in the beginning, they just sign in and leave or just sit around and twiddle their thumbs. No, that isn’t a new technique that is being taught! There just isn’t room for the new interns and the ones already there need to finish up so they can pass their patients off to the new interns. Are they being charged for this downtime? Yes, and they are not happy about that. They were told they will never be able to pay off their loans and now they are paying for this experience to count the holes in the ceiling tiles in the clinics!

They enter their chiropractic education on top of the world and, by the time they leave, they feel like they are the lowest form of animal life on the face of the earth. They also suffer from a sublaxation located at L-5, right where their wallet is located, due to the burden of the student loans. Do they have a warm spot in their hearts for their alma mater? The only warmth there is from heartburn!

Is that the way it should be? No way! Chiropractic students deserve more and should receive more. It’s tough enough once they graduate and go out into the world to set up their practices. Their education experience should be a positive one. There is one basic need that I hear at every campus that I visit. The students need more education in the practical aspects of running a practice. They spend 99% of their time on the science, art and philosophy of chiropractic. Once they receive that piece of paper at graduation, (Not a diploma, but a total of their student loans!!), they must now spend 99% of their time learning how to manage a practice. For most, this is a task for which they are not prepared.

I know that there is a lot for them to learn and so little time to cram it all into them, but they also need to understand the business aspects of practice as well. Because of this void in their education, many turn to so-called “experts” for direction. Usually, all they end up with is another bill. Many students graduate with a chip nailed on their shoulder by the schools. This needs to change for the betterment of the students and for the survival of the profession.

What can be done to help correct some of these problems?

I do have a few observations. I think that the schools should incorporate more in the area of managing a professional practice. I know that they do teach how to fill out an insurance form, but more is needed, such as what to look for in a lease; how to interview and hire CA’s; how to manage personal and office finances; how to evaluate a practice for sale; how to deal with student loans and other debt; how to market; and, most importantly, how to communicate with patients. These things could be added as course-intensives offered over a few weekends or maybe during their downtime when they are in the clinics. Yes, it adds to the overall workload; but it is essential for long-term survival.

I know that I make it sound so simple; but it isn’t. It requires the colleges to change their attitudes toward their students. They need to remember that their students are the future of this profession and, from a selfish point of view, they are future alumni! The colleges need them, and need to treat them as if they were patients that they want to keep for life! The colleges need their support and the future students they can refer, and they also need their donations to survive. That should be the goal of every college.

When students reach graduation, they should feel good about their education and that every penny they borrowed was worth it. Students should want to become active members of their alumni associations and refer future chiropractors to their alma maters.

This is the 21st century and it is time for the colleges to step up and join the times.

They need to get real about how they educate the students and treat them as the professionals that they will be. The key word here is respect.

Stanley B. Greenfield has been engaged in the fields of Financial Management and Insurance since 1962. He is a Registered Financial Consultant, and was awarded the designation of RHU, Registered Professional Disability and Health Insurance Underwriter, in 1979, as one of its Charter Members.

Mr. Greenfield has authored thousands of articles concerning tax, financial, and practice management, and has spoken throughout the world on these subjects to both business and professional associations. He is a regular contributor to numerous other professional journals.

Mr. Greenfield also serves as a member of the Board of Directors of the Florida Chiropractic Foundation for Education and Research. You may reach him at [email protected], call 800-585-1555 or 904-513-2229 or visit his website www.stanleygreenfield.com.

What is Accreditation?

In the United States, accreditation is extended through nongovernmental, voluntary accreditation entities. Accreditation is a system for recognizing educational institutions and affiliated professional programs for a level of performance. The Council on Chiropractic Education (CCE), like other accreditation entities, examines the self-study review provided by the program/institution, student achievements, and financial and support services. The self-study encourages an institution or program to look for improvements. The accreditation process includes a site visit (peer review), to verify the self-study, and includes a report for compliance and improvement. The accreditation process seeks to reassure the public that the program and/or institution is providing a quality higher education product.

Who is CCE?

The CCE is the recognized accreditation body for chiropractic education, a not-for-profit corporation, whose history began in 1935. After many organizational changes, the CCE was incorporated in 1971 and remains an autonomous organization. The United States Department of Education and the nongovernmental Council on Higher Education Accreditation recognize CCE.

What are the Purposes of CCE Accreditation?

To encourage continuous self-analysis and improvement of the Doctor of Chiropractic programs and institutions by representatives of the institutions administrative staff, faculty, students, governing body, and other appropriate constituencies.
To assure students of quality education in the profession and assure patients of appropriate chiropractic care.
To encourage faculty to anticipate and accomodate new trends and developments in the practice of chiropractic that should be incorporated into the educational process.
To assure the educational community, the general public, and other agencies or organizations that the program has both clearly defined and appropriate objectives, maintains conditions under which these objectives may be expected to be achieved, appears to be substantially accomplishing them, and can be expected to continue to do so.

What makes Accreditation unique?

In most other countries, the establishment and maintenance of educational standards is the responsibility of a central government bureau. In the United States, public authority in education is constitutionally reserved to the states; U.S. accreditation is a private, voluntary process.

If there are any questions regarding CCE, or to obtain copies of Standards and Policies, please visit www.cce-usa.org online, or contact the CCE Executive Director, Dr. Martha O’Connor at 480-443-8877.

The Symbiotic Relationship Between Our Colleges and Our Future

With the cost of a student’s professional education running about $150,000, plus undergraduate loans, the expense of opening a practice, overhead and personal expenses, we, as educators, must insure the success of our future doctors. The statistics should be 200 doctors graduate, 200 doctors open a practice and succeed. Not just for the sake of the doctor, but for the success of chiropractic. That would be the ideal; but can it be achieved? Yes, it can be achieved and, more importantly, it must be achieved.

As a profession, we are on the brink of greatness, provided that our future doctors are more equipped for success and leadership as well as becoming doctors. Our curriculums must prepare our future doctors on many levels to be successful in the real world

The immortal words of the late Rodney Dangerfield, “It’s a jungle out there,” describe what I experienced when I entered the real world. I was far from prepared, and it took a lot of time, energy, prayers and money to succeed. Three decades and many causalities later, I still hear the same battle cry from the newly graduated doctors. “It’s a jungle out there,” an ever changing jungle with new challenges aimed at our profession on a constant basis. Practicing today, compared to when I graduated in 1976, is much different. But, the old adage “the more things change the more they stay the same” is true in this case; prepare the doctors to develop the right character, instill leadership and success principles and watch them conquer the world. What good is it to give our doctors a great education, which prepares them to pass the boards and the state exams, but does not prepare them to succeed in practice?

Look at the impact this is having on our profession. The more doctors we send out into this jungle unprepared, the weaker our profession becomes. Many doctors in our profession are just barely making it, and some, sadly, have given up. I say it’s time that we prepare our future doctors for success so that, when they leave school, they will make a huge impact on our society. God knows we need it.

Let’s not leave this important part of a doctor’s education out of their chiropractic curriculum. Let’s realize that developing a student into a professional is a process that requires time. Becoming a doctor is a process that starts the day they enter school and master many years later. It’s not about jamming 10 billion facts into an already stressed mind. It’s about teaching them leadership skills, building their character using encouragement and enthusiasm, preparing them to enter the role of doctor when they graduate and ensuring their success.

This should be the back-bone (no pun intended) of the curriculum, and should start the first semester and build so that, when this doctor walks out of an institution, he/she will know how to start a practice, make it a success, and influence and impact the world. With their success, the assurance of our success is guaranteed. They are more likely to refer future chiropractors to their alma maters, and, when colleges ask for contributions from their alumni, they will not have to ask twice.

If we want our profession to flourish, our institutions must prepare our future doctors to succeed, no matter what the circumstances. The rest will be “history.”

For more information on Dr. Cima and the many books he has written, you may visit his web site at www.cimasystem.com.